San Francisco Public Health Department (E-Cigarette FOIA Request Result)

Tomas J. Aragon <medepi@gmail.com>

SF Health Commission electronic cigarettes policydiscussion

Rajiv Bhatia <Rajiv.Bhatia@sfdph.org> Thu, Jan 13, 2011 at 12:50 PMTo: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>, aragon@berkeley.edu, Audrey Lawrence<Audrey.Lawrence@flysfo.com>, Cecilia Mangoba <Cecilia.Mangoba@sfgov.org>, Vickie Wells<Vickie.Wells@sfdph.org>

Please review the thread below.

Regardless of the FDA authority...it does seem that sfo could bane-cigarettes from its own property as a policy matter -- furthermore citygovernment could ban these from public property within SF.

Based on the facts outlined in the FDA memo and the confusion these willcreate for our enforcement of smoking laws, I think there is adequatereason to ask the Commission to consider a policy position based on thehazards of the cigarettes both to people as well as tobacco controlefforts. This will support SFO's request. I am hoping that the Dept'stobacco control program may concur with this approach.

I am requesting that you propose a commission discussion on this matter asa next step -- thank you.

AlyonikHrushow/DPH/SFGOV

To01/13/2011 11:02 Rajiv Bhatia/DPH/SFGOV@SFGOVAM cc

aragon@berkeley.edu, AudreyLawrence<Audrey.Lawrence@flysfo.com>,Cecilia Mangoba/CTYATT@CTYATT,Vickie Wells

<Vickie.Wells@sfdph.org>Subject

Re: FW: Form to fill out re:electronic cigarettes(Documentlink: Rajiv Bhatia)

RajivHere is info from the FDA re potential risks of e cigarettes.

http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM173430.pdf

Alyonik HrushowSan Francisco Tobacco Free Project

RajivBhatia/DPH/SFGOV

To01/13/2011 09:03 Alyonik Hrushow/DPH/SFGOV@SFGOVAM cc

aragon@berkeley.edu, AudreyLawrence<Audrey.Lawrence@flysfo.com>,Cecilia Mangoba/CTYATT@CTYATT,Vickie Wells<Vickie.Wells@sfdph.org>

SubjectRe: FW: Form to fill out re:electronic cigarettes(Documentlink: Alyonik Hrushow)

alyonik

i woud be interested in your opinions on tobacco control perspective on thepos and negative role of e-cigarettes

Cecilia Mangoba/CTYATT@CTYATT,aragon@berkeley.edu, AudreyLawrence<Audrey.Lawrence@flysfo.com>,Vickie Wells<Vickie.Wells@sfdph.org>

SubjectRe: FW: Form to fill out re:electronic cigarettes(Documentlink: Rajiv Bhatia)

Rajiv, Tomas and Audrey,

There is very current info on the Technical Assistance Legal Center (TALC)on e cigarettes which includes a discussion re how local governments canregulate e cigarettes (see link below).http://www.phlpnet.org/tobacco-control/question/what-latest-lawsuit-chall

According to TALC, a private business can adopt a policy banning ecigarettes. I would think that this would apply to a government agency aswell. Additionally, local second hand smoke ordinances can include ecigs in their definitions of smoking and ban e cig use that way. SanFrancisco recently adopted a more restrictive second hand smoke ordinancebut the ordinance does not cover e cigarettes. The ordinance was based onextensive research findings re the hazards of second hand smoke while thereis no combustion with e cigs. I don't believe that the sponsor of thesecond hand smoke ordinance would want to open up the ordinance foramendments at this time.

Local tobacco permit ordinances can also regulate the sale of e cigs byrequiring tobacco permits for their sale. Our local ordinance does not dothat.and TRLs can require permits for e cigs.

jBhatia/DPH/SFGOV

To01/12/2011 08:49 Audrey LawrenceAM <Audrey.Lawrence@flysfo.com>,

Alyonik Hrushow/DPH/SFGOV@SFGOV,aragon@berkeley.edu

ccVickie Wells<Vickie.Wells@sfdph.org>

Audrey,

I'm forwarding this to Tomas Aragon our new health officer. I don't think Ishould take an individual position here and this would be a policy matterfor the Commission. The Commission has strongly supported smokingprevention activities so I think they would be interested in consideringthis.

I am also copying Alyonik Hrushow who plays a lead role in tobaccoprevention efforts.

Audrey Lawrence<Audrey.Lawrence@flysfo.com> To

Rajiv Bhatia01/12/2011 08:44 <Rajiv.Bhatia@sfdph.org>AM cc

Vickie Wells<Vickie.Wells@sfdph.org>

SubjectFW: Form to fill out re: electroniccigarettes

-| ||-|| ||-|

Dr. Bhatia,

Is anyone at DPH investigating the potential hazards of electroniccigarettes? I am trying to recommend an interim ban on the indoor use ofelectronic cigarettes. Our legal staff at SFO are hesitant to place atemporary ban on e cigarettes pending regulation from the FDA.

Would you be willing to support a temporary ruling on the indoor use of ecigarettes?

Thank you for your time and assistance on this issue.

Audrey Lawrence, MPH CIH | S.F. International Airport

Manager of Safety and Health, Administration------------------------------------------------|P.O. Box 8097 | San Francisco 94128 ||------------------------------------------------||Phone: 650-821-7889 | Fax: 650-821-5596 ||------------------------------------------------|www.flysfo.com

September 23, 2010FDA Continues Fight to Regulate Electronic CigarettesThe Food and Drug Administration has authority to regulate so-called"electronic cigarettes" that vaporize nicotine but do not contain tobacco,a Justice Department lawyer argued today in the U.S. Court of Appeals forthe D.C. Circuit.Last year, a federal judge in Washington ruled the government improperlyblocked an inbound shipment of e-cigarettes into the United States, sayingthat the FDA doesn’t have authority to regulate the product because it isnot marketed for therapeutic uses such as to treat smoking addiction.DOJ’s Alisa Klein of the Civil Division today tried to convince athree-judge appeals court panel to reverse the trial judge’s issuance of aninjunction against the FDA. The appeals court stayed enforcement of theinjunction pending resolution of the dispute.(Embedded image moved to file: pic10117.jpg)Garre_gregory_kagan_#3056D6Latham & Watkins partner Gregory Garre (at left), who chairs the firm’sSupreme Court and appellate practice group, represented Scottsdale,Az.-based Sottera, which sells e-cigarettes under the brand “NJOY.”E-cigarettes are battery-powered devices that resemble real cigarettes. TheFDA blocked the importation of e-cigarettes on the ground that they areunapproved drug devices under the federal Food, Drug and Cosmetic Act.Tobacco products are generally exempt from the drug and device provisionsof the FDCA.The Tobacco Control Act of 2009 gives the FDA authority to regulate“tobacco products,” a term that was closely scrutinized today by theappeals court panel consisting of Judges Merrick Garland and BrettKavanaugh and Senior Judge Stephen Williams.Klein of the Justice Department said the FDA has long regulated nicotineproducts that include smokeless cigarettes, nicotine lollipops and nicotineinhalers. In 2008, the FDA refused to allow the importation of “Nicogel,” ahand gel made of liquefied tobacco. The FDA said the gel was an unapproveddrug.“If electronic cigarettes are a safe method of nicotine maintenance, thatcould be approved if the science supports it,” Klein said in court.Garland questioned what he called the “unique” procedural element of thecase. The government’s position in the litigation is established in ablocking order—stopping the shipment of electronic cigarettes—and not in adetailed administrative record. Kavanaugh and Williams examined the extentto which Congress can step in to fill a regulatory void to clarify thescope of FDA regulatory authority.Garre, arguing for NJOY, said the product is not marketed as a smokingcessation device. He said if the FDA could show that the e-cigarettes aremarketed for therapeutic reasons, the injunction against the FDA would notapply.Posted by Mike Scarcella on September 23, 2010 at 01:14 PM in CurrentAffairs, D.C. Courts and Government, Food and Drink, Justice Department ,Politics and Government , Travel, Web/Tech | Perma

[attachment "Exec Com Policy Form E Cigarettes.docx" deleted by RajivBhatia/DPH/SFGOV]

Bhatia/DPH/SFGOV]

pic10117.jpg7K

electronic cigarettes10 messages

Rajiv Bhatia <Rajiv.Bhatia@sfdph.org> Tue, Jan 18, 2011 at 7:59 AMTo: Tomas Aragon <tomas.aragon@sfdph.org>Cc: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>, Audrey Lawrence <Audrey.Lawrence@flysfo.com>, CeciliaMangoba <Cecilia.Mangoba@sfgov.org>, medepi@gmail.com, Vickie Wells <Vickie.Wells@sfdph.org>

Tomas:

Thanks. Based on available science, I'm not sure that we will be able todemonstrate involuntary adverse inhalational exposure to nicotine.

There may be other important arguements to consider including two that arestated concerns of the FDA (see their factsheet): potential for supportingaddiction and lack of safety testing for the user.

Although we have not yet encountered this, allowing e-cigs may complicateefforts for the city, restaurants, and workplaces to enforce no-smokingpolicies. This may be a fourth arguement.

It may also be helpful to review the several instances where e-cigarettesor public-area use has already been banned and the rationale for the bans(e.g. Canada, King County).

Tomas Aragon<tomas.aragon@sfdph.org> ToSent by: Alyonik Hrushowmedepi@gmail.com <Alyonik.Hrushow@sfdph.org>

ccRajiv Bhatia

01/17/2011 09:59 <Rajiv.Bhatia@sfdph.org>, AudreyPM Lawrence

<Audrey.Lawrence@flysfo.com>,Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>, VickieWells <Vickie.Wells@sfdph.org>

SubjectRe: FW: Form to fill out re:electronic cigarettes

Alyonik, Can we organize a meeting to review this topic?* Is nicotine a drug? (yes)* Does e-cigs result in vaporized nicotine that is involuntary inhaled bybystanders? (?yes)* Does inhaled vaporized nicotine alone cause adverse physiologicresponses? (yes: coronary artery vasoconstriction, bronchospasm, etc.)* What are the other toxicants / chemicals in e-cig vapors?

If the first three bullets are yes, then I think SFO has sufficient reasonto ban e-cigs to prevent the involuntary exposure to nicotine with knowadverse pharmacological effects.

Can you:* identify key stakeholders to attend* prepare draft agenda* identify pre-meeting key tasks (and suggest who can do them)

Then, we can schedule.

=======Tomás J. Aragón, MD, DrPH, Health OfficerDirector, Population Health & PreventionSan Francisco Department of Public Health101 Grove St, Rm 308, SF CA 94102-4505G-Phone: 415-78-SALUD (415-787-2583)

On Fri, Jan 14, 2011 at 8:13 AM, Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> wrote:

RajivCecilia just alerted me that I omitted the word not below in my originalemail, which completely changes the meaning of the sentence.Alyonik HrushowSan Francisco Tobacco Free Project

__________________

The FDA can regulate nicotine in products that are drugs or drug deliverydevices such as stop smoking aids. But the court of appeal held that ecigs are not marketed as cessation devices and that the FDA does not haveauthority over e cigarettes as a drug or delivery device. The FDA hasauthority regulate tobacco products as prescribed in the 2009 FamilySmoking Prevention and Tobacco Control Act, which Philip Morris helpedcraft by the way. I don't believe e cigarettes can be regulated by FDAunder this piece of legislation.

Alyonik HrushowSan Francisco Tobacco Free Project RajivBhatia/DPH/SFGOV To01/13/2011 12:40 Alyonik Hrushow/DPH/SFGOV@SFGOVPMcc aragon@berkeley.edu,AudreyLawrence <Audrey.Lawrence@flysfo.com>, CeciliaMangoba/CTYATT@CTYATT, VickieWells <Vickie.Wells@sfdph.org>Subject Re: FW: Form to fill outre: electroniccigarettes(Document link: AlyonikHrushow)

thank you -- can FDA declare nicotine to be a drug?AlyonikHrushow/DPH/SFGOV To01/13/2011 11:02 Rajiv Bhatia/DPH/SFGOV@SFGOVAMcc aragon@berkeley.edu,AudreyLawrence <Audrey.Lawrence@flysfo.com>, CeciliaMangoba/CTYATT@CTYATT, VickieWells <Vickie.Wells@sfdph.org>Subject Re: FW: Form to fill outre: electroniccigarettes(Document link: RajivBhatia)

p g p p

Alyonik HrushowSan Francisco Tobacco Free Project RajivBhatia/DPH/SFGOV To01/13/2011 09:03 Alyonik Hrushow/DPH/SFGOV@SFGOVAMcc aragon@berkeley.edu,AudreyLawrence <Audrey.Lawrence@flysfo.com>, CeciliaMangoba/CTYATT@CTYATT, VickieWells <Vickie.Wells@sfdph.org>Subject Re: FW: Form to fill outre: electroniccigarettes(Document link: AlyonikHrushow)

alyonik

i woud be interested in your opinions on tobacco control perspective onthepos and negative role of e-cigarettes

rajiv AlyonikHrushow/DPH/SFGOV To01/13/2011 08:58 Rajiv Bhatia/DPH/SFGOV@SFGOVAMcc CeciliaMangoba/CTYATT@CTYATT,aragon@berkeley.edu, AudreyLawrence <Audrey.Lawrence@flysfo.com>, VickieWells <Vickie.Wells@sfdph.org>Subject Re: FW: Form to fill outre: electroniccigarettes(Document link: RajivBhatia)

There is very current info on the Technical Assistance Legal Center(TALC)on e cigarettes which includes a discussion re how local governments canregulate e cigarettes (see link below).http://www.phlpnet.org/tobacco-control/question/what-latest-lawsuit-chall

According to TALC, a private business can adopt a policy banning ecigarettes. I would think that this would apply to a government agencyaswell. Additionally, local second hand smoke ordinances can include ecigs in their definitions of smoking and ban e cig use that way. SanFrancisco recently adopted a more restrictive second hand smoke ordinancebut the ordinance does not cover e cigarettes. The ordinance was basedonextensive research findings re the hazards of second hand smoke whilethereis no combustion with e cigs. I don't believe that the sponsor of thesecond hand smoke ordinance would want to open up the ordinance foramendments at this time.

Local tobacco permit ordinances can also regulate the sale of e cigs byrequiring tobacco permits for their sale. Our local ordinance does notdothat. and TRLs can require permits for e cigs.

Alyonik HrushowSan Francisco Tobacco Free Project RajivBhatia/DPH/SFGOV To01/12/2011 08:49 Audrey LawrenceAM <Audrey.Lawrence@flysfo.com>, AlyonikHrushow/DPH/SFGOV@SFGOV,aragon@berkeley.edu

cc VickieWells <Vickie.Wells@sfdph.org>Subject Re: FW: Form to fill outre: electroniccigarettes(Document link: AlyonikHrushow)

Audrey,

I'm forwarding this to Tomas Aragon our new health officer. I don't thinkIshould take an individual position here and this would be a policy matterfor the Commission. The Commission has strongly supported smokingprevention activities so I think they would be interested in consideringthis.

rajiv Audrey Lawrence <Audrey.Lawrence@flysfo.com> ToRajiv Bhatia 01/12/2011 08:44 <Rajiv.Bhatia@sfdph.org>AMcc VickieWells <Vickie.Wells@sfdph.org>Subject FW: Form to fill out re:electronic cigarettes -| ||-|| ||-|

Dr. Bhatia,

Thank you for your time and assistance on this issue. Audrey Lawrence,MPH CIH | S.F. International A irport Manager of Safety and Health,Administration ------------------------------------------------|P.O. Box 8097 | San Francisco 94128 ||------------------------------------------------||Phone: 650-821-7889 | Fax: 650-821-5596 ||------------------------------------------------| www.flysfo.com

September 23, 2010FDA Continues Fight to Regulate Electronic CigarettesThe Food and Drug Administration has authority to regulate so-called"electronic cigarettes" that vaporize nicotine but do not containtobacco,a Justice Department lawyer argued today in the U.S. Court of Appeals forthe D.C. Circuit.Last year, a federal judge in Washington ruled the government improperlyblocked an inbound shipment of e-cigarettes into the United States,sayingthat the FDA doesn’t have authority to regulate the product because it isnot marketed for therapeutic uses such as to treat smoking addiction.DOJ’s Alisa Klein of the Civil Division today tried to convince athree-judge appeals court panel to reverse the trial judge’s issuance ofaninjunction against the FDA. The appeals court stayed enforcement of theinjunction pending resolution of the dispute.(Embedded image moved to file: pic09735.jpg)Garre_gregory_kagan_#3056D6Latham & Watkins partner Gregory Garre (at left), who chairs the firm’sSupreme Court and appellate practice group, represented Scottsdale,Az.-based Sottera, which sells e-cigarettes under the brand “NJOY.”E-cigarettes are battery-powered devices that resemble real cigarettes.TheFDA blocked the importation of e-cigarettes on the ground that they areunapproved drug devices under the federal Food, Drug and Cosmetic Act.Tobacco products are generally exempt from the drug and device provisionsof the FDCA.The Tobacco Control Act of 2009 gives the FDA authority to regulate“tobacco products,” a term that was closely scrutinized today by theappeals court panel consisting of Judges Merrick Garland and BrettKavanaugh and Senior Judge Stephen Williams.Klein of the Justice Department said the FDA has long regulated nicotineproducts that include smokeless cigarettes, nicotine lollipops andnicotineinhalers. In 2008, the FDA refused to allow the importation of “Nicogel,”ahand gel made of liquefied tobacco. The FDA said the gel was anunapproveddrug.“If electronic cigarettes are a safe method of nicotine maintenance, thatcould be approved if the science supports it,” Klein said in court.Garland questioned what he called the “unique” procedural element of thecase. The government’s position in the litigation is established in ablocking order—stopping the shipment of electronic cigarettes—and not inadetailed administrative record. Kavanaugh and Williams examined theextentto which Congress can step in to fill a regulatory void to clarify thescope of FDA regulatory authority.Garre, arguing for NJOY, said the product is not marketed as a smokingcessation device. He said if the FDA could show that the e-cigarettes aremarketed for therapeutic reasons, the injunction against the FDA wouldnot

notapply.Posted by Mike Scarcella on September 23, 2010 at 01:14 PM in CurrentAffairs, D.C. Courts and Government, Food and Drink, Justice Department ,Politics and Government , Travel, Web/Tech | Perma [attachment "Exec ComPolicy Form E Cigarettes.docx" deleted by RajivBhatia/DPH/SFGOV]

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Tue, Jan 18, 2011 at 9:28 AMTo: Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>Cc: Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Cecilia Mangoba <Cecilia.Mangoba@sfgov.org>,medepi@gmail.com, Tomas Aragon <tomas.aragon@sfdph.org>, Vickie Wells <Vickie.Wells@sfdph.org>

TomasI have not seen anything that suggests there is science showing that e-cigsresult in vaporized nicotine that is involuntary inhaled by bystanders.

I agree with Rajiv re other important arguments to consider in addition tothe concerns identified by the FDA. I will also look into rationale usedby local governments to ban e cigarettes.

I will be happy to work on the following 3 tasks and will get back to youwith the requested information.

* identify key stakeholders to attend* prepare draft agenda* identify pre-meeting key tasks (and suggest who can do them)

To01/18/2011 07:59 Tomas AragonAM <tomas.aragon@sfdph.org>

ccAlyonik Hrushow<Alyonik.Hrushow@sfdph.org>, AudreyLawrence<Audrey.Lawrence@flysfo.com>,Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>,medepi@gmail.com, Vickie Wells<Vickie.Wells@sfdph.org>

Subject

[Quoted text hidden]

Rajiv Bhatia <Rajiv.Bhatia@sfdph.org> Tue, Jan 18, 2011 at 10:06 AMTo: Cecilia Mangoba <Cecilia.Mangoba@sfgov.org>Cc: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>, Audrey Lawrence <Audrey.Lawrence@flysfo.com>,medepi@gmail.com, Tomas Aragon <tomas.aragon@sfdph.org>, Vickie Wells <Vickie.Wells@sfdph.org>

thanks, it seems like they use a similarly broad set of arguments

CeciliaMangoba/CTYATT@CTYATT To

Alyonik Hrushow/DPH/SFGOV@SFGOV01/18/2011 10:00 ccAM Audrey Lawrence

<Audrey.Lawrence@flysfo.com>,medepi@gmail.com, RajivBhatia/DPH/SFGOV@SFGOV, TomasAragon <tomas.aragon@sfdph.org>,Vickie Wells<Vickie.Wells@sfdph.org>

SubjectRe: electronic cigarettes(Documentlink: Rajiv Bhatia)

Here is the King County ordinance:

[attachment "electronic cigs reg.pdf" deleted by Rajiv Bhatia/DPH/SFGOV]

Cecilia T. MangobaDeputy City AttorneyOffice of San Francisco City Attorney Dennis J. Herrera1390 Market Street, 5th FloorSan Francisco, CA 94102Phone: (415) 554-3927Fax: (415) 554-4248

CONFIDENTIAL COMMUNICATIONThis message is subject to an attorney-client privilege and/or attorneywork product privilege and must not be disclosed. If you received thisemail inadvertently, please permanently delete it.

From: Alyonik Hrushow/DPH/SFGOV@SFGOVTo: Rajiv Bhatia/DPH/SFGOV@SFGOV

To: Rajiv Bhatia/DPH/SFGOV@SFGOV

Cc: Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>, medepi@gmail.com, Tomas Aragon<tomas.aragon@sfdph.org>, Vickie Wells <Vickie.Wells@sfdph.org>

Date: 01/18/2011 09:29 AMSubject: Re: electronic cigarettes

Cecilia Mangoba <Cecilia.Mangoba@sfgov.org> Tue, Jan 18, 2011 at 10:00 AMTo: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>Cc: Audrey Lawrence <Audrey.Lawrence@flysfo.com>, medepi@gmail.com, Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>,Tomas Aragon <tomas.aragon@sfdph.org>, Vickie Wells <Vickie.Wells@sfdph.org>

CONFIDENTIAL COMMUNICATIONThis message is subject to an attorney-client privilege and/or attorney work product privilege and must not bedisclosed. If you received this email inadvertently, please permanently delete it.

From: Alyonik Hrushow/DPH/SFGOV@SFGOV

To: Rajiv Bhatia/DPH/SFGOV@SFGOVCc: Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Cecilia Mangoba <Cecilia.Mangoba@sfgov.org>, medepi@gmail.com, Tomas

Aragon <tomas.aragon@sfdph.org>, Vickie Wells <Vickie.Wells@sfdph.org>

Date: 01/18/2011 09:29 AM

Subject: Re: electronic cigarettes

I have not seen anything that suggests there is science showing that e-cigs result in vaporized nicotinethat is involuntary inhaled by bystanders.

I agree with Rajiv re other important arguments to consider in addition to the concerns identified by the FDA. Iwill also look into rationale used by local governments to ban e cigarettes.

I will be happy to work on the following 3 tasks and will get back to you with the requested information.

* identify key stakeholders to attend* prepare draft agenda* identify pre-meeting key tasks (and suggest who can do them)

Rajiv Bhatia/DPH/SFGOV

01/18/2011 07:59 AM

To Tomas Aragon <tomas.aragon@sfdph.org>

cc Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>, Audrey Lawrence<Audrey.Lawrence@flysfo.com>, Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>, medepi@gmail.com, Vickie Wells<Vickie.Wells@sfdph.org>

Subject electronic cigarettesLink

Tomas:

Thanks. Based on available science, I'm not sure that we will be able to demonstrate involuntary adverseinhalational exposure to nicotine.

There may be other important arguements to consider including two that are stated concerns of the FDA (see theirfactsheet): potential for supporting addiction and lack of safety testing for the user.

Although we have not yet encountered this, allowing e-cigs may complicate efforts for the city, restaurants, andworkplaces to enforce no-smoking policies. This may be a fourth arguement.

It may also be helpful to review the several instances where e-cigarettes or public-area use has already beenbanned and the rationale for the bans (e.g. Canada, King County).

Tomas Aragon <tomas.aragon@sfdph.org>Sent by: medepi@gmail.com

01/17/2011 09:59 PM

To Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>

cc Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>, Audrey Lawrence<Audrey.Lawrence@flysfo.com>, Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>, Vickie Wells <Vickie.Wells@sfdph.org>

Subject Re: FW: Form to fill out re: electronic cigarettes

electronic cigs reg.pdf324K

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Tue, Jan 18, 2011 at 10:27 AMTo: Cecilia Mangoba <Cecilia.Mangoba@sfgov.org>Cc: Audrey Lawrence <Audrey Lawrence@flysfo com> medepi@gmail com Rajiv Bhatia <Rajiv Bhatia@sfdph org>

Cc: Audrey Lawrence <Audrey.Lawrence@flysfo.com>, medepi@gmail.com, Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>,

Tomas Aragon <tomas.aragon@sfdph.org>, Vickie Wells <Vickie.Wells@sfdph.org>

Thanks, CeciliaI see these regulations were adopted by the Board of Health, not a countyboard of supervisors.Are you aware of other laws banning e cigarettes? Rajiv mentioned Canada.I am checking with TALC.

Alyonik Hrushow/DPH/SFGOV@SFGOV01/18/2011 10:00 ccAM Audrey Lawrence

SubjectRe: electronic cigarettes(Documentlink: Alyonik Hrushow)

[attachment "electronic cigs reg.pdf" deleted by Alyonik Hrushow/DPH/SFGOV]

Subjectelectronic cigarettes(Document

link: Alyonik Hrushow)

Tomas:

ccRajiv Bhatia

Rajiv Bhatia <Rajiv.Bhatia@sfdph.org> Tue, Jan 18, 2011 at 10:51 AMTo: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>Cc: Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Cecilia Mangoba <Cecilia.Mangoba@sfgov.org>,medepi@gmail.com, Tomas Aragon <tomas.aragon@sfdph.org>, Vickie Wells <Vickie.Wells@sfdph.org>

alyonik,

current leg efforts are ongoing in new jersey, pennslyvania, new hamshire--

i've seen some press on these

flavoring and child addition are leading rationales

To01/18/2011 10:27 Cecilia Mangoba/CTYATT@CTYATTAM cc

Audrey Lawrence<Audrey.Lawrence@flysfo.com>,medepi@gmail.com, RajivBhatia/DPH/SFGOV@SFGOV, TomasAragon <tomas.aragon@sfdph.org>,Vickie Wells<Vickie.Wells@sfdph.org>

SubjectRe: electronic cigarettes(Documentlink: Rajiv Bhatia)

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Tue, Jan 18, 2011 at 10:57 AMTo: Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>Cc: Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Cecilia Mangoba <Cecilia.Mangoba@sfgov.org>,medepi@gmail.com, Tomas Aragon <tomas.aragon@sfdph.org>, Vickie Wells <Vickie.Wells@sfdph.org>

Thanks, Rajiv

Audrey Lawrence<Audrey.Lawrence@flysfo.com>,Cecilia Mangoba/CTYATT@CTYATT,medepi@gmail.com, Tomas Aragon<tomas.aragon@sfdph.org>, VickieWells <Vickie.Wells@sfdph.org>

Cecilia Mangoba <Cecilia.Mangoba@sfgov.org> Tue, Jan 18, 2011 at 12:49 PMTo: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>Cc: Audrey Lawrence <Audrey.Lawrence@flysfo.com>, medepi@gmail.com, Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>,T A t @ fd h Vi ki W ll Vi ki W ll @ fd h

Tomas Aragon <tomas.aragon@sfdph.org>, Vickie Wells <Vickie.Wells@sfdph.org>

I had also reached out to TALC and just received the following from them:

The state of New Jersey added e-cigarettes to its law banning smoking in indoor enclosed spaces and workplaces,so that the use of e-cigarettes in those places is also illegal. The text of the law is here: http://njgasp.org/E-Cigs_A4227.PDF

Other jurisdictions have also passed restrictions on e-cigarette use. I know of some and have heard anecdotallyabout others. Here is a list, with links where I have them:

Paramus, NJ banned e-cigarette use in indoor public spaces and workplaces. A copy of the ordinance is here:http://www.njgasp.org/Electronic%20Cigarettes%20Paramus%20Ordinance%2012-2009.pdf

Suffolk County, NY banned the use of e-cigarettes in public places and workplaces in late 2009.

In October 2009, Bergen County, NJ passed a resolution to ban the use of e-cigarettes in county buildings and atcounty parks.

I also heard there was legislation introduced in Maryland that would ban the use of e-cigarettes in places wheresmoking is banned, but I'm not sure of current status of that bill.

To: Cecilia Mangoba/CTYATT@CTYATTCc: Audrey Lawrence <Audrey.Lawrence@flysfo.com>, medepi@gmail.com, Rajiv Bhatia/DPH/SFGOV@SFGOV, Tomas Aragon

<tomas.aragon@sfdph.org>, Vickie Wells <Vickie.Wells@sfdph.org>

Date: 01/18/2011 10:29 AM

Subject: Re: electronic cigarettes

Thanks, CeciliaI see these regulations were adopted by the Board of Health, not a county board of supervisors.Are you aware of other laws banning e cigarettes? Rajiv mentioned Canada. I am checking with TALC.

Cecilia Mangoba/CTYATT@CTYATT

01/18/2011 10:00 AM

To Alyonik Hrushow/DPH/SFGOV@SFGOV

cc Audrey Lawrence <Audrey.Lawrence@flysfo.com>, medepi@gmail.com,Rajiv Bhatia/DPH/SFGOV@SFGOV, Tomas Aragon<tomas.aragon@sfdph.org>, Vickie Wells <Vickie.Wells@sfdph.org>

Subject Re: electronic cigarettesLink

01/18/2011 07:59 AM

To Tomas Aragon <tomas.aragon@sfdph.org>

cc Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>, Audrey Lawrence<Audrey.Lawrence@flysfo.com>, Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>, medepi@gmail.com, Vickie Wells<Vickie.Wells@sfdph.org>

Subject electronic cigarettesLink

Tomas:

Thanks. Based on available science, I'm not sure that we will be able to demonstrate involuntary adverseinhalational exposure to nicotine.

There may be other important arguements to consider including two that are stated concerns of the FDA (see theirfactsheet): potential for supporting addiction and lack of safety testing for the user.

Although we have not yet encountered this, allowing e-cigs may complicate efforts for the city, restaurants, andworkplaces to enforce no-smoking policies. This may be a fourth arguement.

It may also be helpful to review the several instances where e-cigarettes or public-area use has already beenbanned and the rationale for the bans (e.g. Canada, King County).

Tomas Aragon <tomas.aragon@sfdph.org>Sent by: medepi@gmail.com

01/17/2011 09:59 PM

To Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>

cc Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>, Audrey Lawrence<Audrey.Lawrence@flysfo.com>, Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>, Vickie Wells <Vickie.Wells@sfdph.org>

Subject Re: FW: Form to fill out re: electronic cigarettes

Cecilia Mangoba <Cecilia.Mangoba@sfgov.org> Tue, Jan 18, 2011 at 12:49 PMTo: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>Cc: Audrey Lawrence <Audrey.Lawrence@flysfo.com>, medepi@gmail.com, Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>,Tomas Aragon <tomas.aragon@sfdph.org>, Vickie Wells <Vickie.Wells@sfdph.org>

YATT ToAlyonik Hrushow/DPH/SFGOV@SFGOV

01/18/2011 10:00 ccAM Audrey Lawrence

SubjectRe: electronic cigarettes(Documentlink: Alyonik Hrushow)

Subjectelectronic cigarettes(Document

link: Alyonik Hrushow)

Tomas:

ccRajiv Bhatia

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Tue, Jan 18, 2011 at 1:43 PMTo: Cecilia Mangoba <Cecilia.Mangoba@sfgov.org>Cc: rajiv.bhatia@sfdph.org, tomas.aragon@sfdph.org

Thanks CeciliaAn additional piece of info I asked Elisa at TALC for was any science reinvoluntary adverse inhalational exposure to nicotine. Her response ispasted in below.

As far as secondhand "smoke" from e-cigarettes being inhaled by others,I don't know of any studies specifically on that issue. I did see thisarticle about a thirdhand smoke study, which touches on e-cigarettes:http://www.sciencedaily.com/releases/2010/02/100208154651.htmQuote from article:Co-author James Pankow points out that the results of this study shouldraise concerns about the purported safety of electronic cigarettes. ..."Nicotine, the addictive substance in tobacco smoke, has until now beenconsidered to be non-toxic in the strictest sense of the term," saysKamlesh Asotra of the University of California's Tobacco-Related DiseaseResearch Program, which funded this study. "What we see in this study is

that the reactions of residual nicotine with nitrous acid at surface

interfaces are a potential cancer hazard, and these results may be justthe tip of the iceberg."

Perhaps you can take a look at the study described in the article to seewhat info it has that might be useful as you work on developing findingsfor your ordinance.

Alyonik Hrushow/DPH/SFGOV@SFGOV01/18/2011 12:49 cc

Re: FW: Form to fill out re: electronic cigarettes15 messages

Rajiv Bhatia <Rajiv.Bhatia@sfdph.org> Wed, Jan 12, 2011 at 8:49 AMTo: Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>,aragon@berkeley.eduCc: Vickie Wells <Vickie.Wells@sfdph.org>

Audrey,

Vickie Wells<Vickie.Wells@sfdph.org>

SubjectFW: Form to fill out re: electroniccigarettes

||||||||

Dr. Bhatia,

Manager of Safety and Health, Administration------------------------------------------------|P.O. Box 8097 | San Francisco 94128 ||------------------------------------------------||Phone: 650-821-7889 | Fax: 650-821-5596 ||------------------------------------------------|www.flysfo.com

September 23, 2010FDA Continues Fight to Regulate Electronic CigarettesThe Food and Drug Administration has authority to regulate so-called"electronic cigarettes" that vaporize nicotine but do not contain tobacco,a Justice Department lawyer argued today in the U.S. Court of Appeals for

p y g y ppthe D.C. Circuit.Last year, a federal judge in Washington ruled the government improperlyblocked an inbound shipment of e-cigarettes into the United States, sayingthat the FDA doesn’t have authority to regulate the product because it isnot marketed for therapeutic uses such as to treat smoking addiction.DOJ’s Alisa Klein of the Civil Division today tried to convince athree-judge appeals court panel to reverse the trial judge’s issuance of aninjunction against the FDA. The appeals court stayed enforcement of theinjunction pending resolution of the dispute.(Embedded image moved to file: pic13149.jpg)Garre_gregory_kagan_#3056D6Latham & Watkins partner Gregory Garre (at left), who chairs the firm’sSupreme Court and appellate practice group, represented Scottsdale,Az.-based Sottera, which sells e-cigarettes under the brand “NJOY.”E-cigarettes are battery-powered devices that resemble real cigarettes. TheFDA blocked the importation of e-cigarettes on the ground that they areunapproved drug devices under the federal Food, Drug and Cosmetic Act.Tobacco products are generally exempt from the drug and device provisionsof the FDCA.The Tobacco Control Act of 2009 gives the FDA authority to regulate“tobacco products,” a term that was closely scrutinized today by theappeals court panel consisting of Judges Merrick Garland and BrettKavanaugh and Senior Judge Stephen Williams.Klein of the Justice Department said the FDA has long regulated nicotineproducts that include smokeless cigarettes, nicotine lollipops and nicotineinhalers. In 2008, the FDA refused to allow the importation of “Nicogel,” ahand gel made of liquefied tobacco. The FDA said the gel was an unapproveddrug.“If electronic cigarettes are a safe method of nicotine maintenance, thatcould be approved if the science supports it,” Klein said in court.Garland questioned what he called the “unique” procedural element of thecase. The government’s position in the litigation is established in ablocking order—stopping the shipment of electronic cigarettes—and not in adetailed administrative record. Kavanaugh and Williams examined the extentto which Congress can step in to fill a regulatory void to clarify thescope of FDA regulatory authority.Garre, arguing for NJOY, said the product is not marketed as a smokingcessation device. He said if the FDA could show that the e-cigarettes aremarketed for therapeutic reasons, the injunction against the FDA would notapply.Posted by Mike Scarcella on September 23, 2010 at 01:14 PM in CurrentAffairs, D.C. Courts and Government, Food and Drink, Justice Department ,Politics and Government , Travel, Web/Tech | Perma

pic13149.jpg7K

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Thu, Jan 13, 2011 at 8:58 AMTo: Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>Cc: Cecilia Mangoba <Cecilia.Mangoba@sfgov.org>, aragon@berkeley.edu, Audrey Lawrence<Audrey.Lawrence@flysfo.com>, Vickie Wells <Vickie.Wells@sfdph.org>

Vickie.Wells@sfdph.orgSubject

Re: FW: Form to fill out re:electronic cigarettes(Documentlink: Alyonik Hrushow)

(Embedded image moved to file: pic27400.jpg)Garre_gregory_kagan_#3056D6

pic27400.jpg7K

Rajiv Bhatia <Rajiv.Bhatia@sfdph.org> Thu, Jan 13, 2011 at 9:03 AMTo: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>Cc: aragon@berkeley.edu, Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>, Vickie Wells <Vickie.Wells@sfdph.org>

alyonik

pic05078.jpg7K

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Thu, Jan 13, 2011 at 10:50 AMTo: Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>Cc: aragon@berkeley.edu, Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>, Vickie Wells <Vickie.Wells@sfdph.org>

RajivI am hoping that the FDA's appeal will result in their abilitiy to ban ecigarettes. I don't see them as smoking cessation aides, rather as a wayfor smokers to be able to smoke in places where it is forbidden. And wedon't really know what is in these devices as the FDA is not regulatingthem. The state of CA has been sales of e cigs to minors by the way.

Other than that, I don't think it's a good idea to open up the legislationto include e-cigarettes. It would be a huge battle with small businessesagain and it would also provide an opportunity for businesses to weaken ourcurrent legislation which took 5 years to adopt. It would be much easierif the airport promulgated their own policy.

aragon@berkeley.edu, AudreyLawrence<Audrey.Lawrence@flysfo.com>,Cecilia Mangoba/CTYATT@CTYATT,

pic03834.jpg7K

Cecilia Mangoba <Cecilia.Mangoba@sfgov.org> Thu, Jan 13, 2011 at 11:01 AMTo: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>Cc: aragon@berkeley.edu, Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>,Vickie Wells <Vickie.Wells@sfdph.org>

Alyonik - I heard from the DOJ's attorney this morning that they lost thatappeal. They've asked for a rehearing but I don't think we should beoptimistic about a victory at this point.

From: Alyonik Hrushow/DPH/SFGOV@SFGOVTo: Rajiv Bhatia/DPH/SFGOV@SFGOVCc: aragon@berkeley.edu, Audrey Lawrence

<Audrey.Lawrence@flysfo.com>, Cecilia Mangoba/CTYATT@CTYATT,Vickie Wells <Vickie.Wells@sfdph.org>

Date: 01/13/2011 10:52 AM

pic18127.jpg7K

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Thu, Jan 13, 2011 at 11:02 AMTo: Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>Cc: aragon@berkeley.edu, Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>, Vickie Wells <Vickie.Wells@sfdph.org>

pic15091.jpg7K

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Thu, Jan 13, 2011 at 11:05 AMTo: Cecilia Mangoba <Cecilia.Mangoba@sfgov.org>Cc: aragon@berkeley.edu, Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>,Vickie Wells <Vickie.Wells@sfdph.org>

That is disappointing news.

Alyonik Hrushow/DPH/SFGOV@SFGOV01/13/2011 11:01 ccAM aragon@berkeley.edu, Audrey

Lawrence<Audrey.Lawrence@flysfo.com>, RajivBhatia/DPH/SFGOV@SFGOV, VickieWells <Vickie.Wells@sfdph.org>

Alyonik - I heard from the DOJ's attorney this morning that they lost thatappeal. They've asked for a rehearing but I don't think we should beoptimistic about a victory at this point.

From: Alyonik Hrushow/DPH/SFGOV@SFGOVTo: Rajiv Bhatia/DPH/SFGOV@SFGOVCc: aragon@berkeley.edu, Audrey Lawrence

<Audrey.Lawrence@flysfo.com>, Cecilia Mangoba/CTYATT@CTYATT,Vickie Wells <Vickie.Wells@sfdph.org>

Date: 01/13/2011 10:52 AMSubject: Re: FW: Form to fill out re: electronic cigarettes

RajivI am hoping that the FDA's appeal will result in their abilitiy to ban ecigarettes. I don't see them as smoking cessation aides, rather as a wayfor smokers to be able to smoke in places where it is forbidden. And wedon't really know what is in these devices as the FDA is not regulatingthem The state of CA has been sales of e cigs to minors by the way

them. The state of CA has been sales of e cigs to minors by the way.

Other than that, I don't think it's a good idea to open up the legislationto include e-cigarettes. It would be a huge battle with small businessesagain and it would also provide an opportunity for businesses to weaken ourcurrent legislation which took 5 years to adopt. It would be much easierif the airport promulgated their own policy.

pic28203.jpg7K

Cecilia Mangoba <Cecilia.Mangoba@sfgov.org> Thu, Jan 13, 2011 at 11:12 AMTo: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>Cc: aragon@berkeley.edu, Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>,Vickie Wells <Vickie.Wells@sfdph.org>

Note that if the City wants to regulate e-cigs but not reopen the second hand smoke ordinance, we could alwayscreate a new article with findings unique to ecigs and say the smoking restrictions in Article 19F apply. But thescience should support such widespread restrictions on these products. I'm not sure we know enough about thehealth impacts. In the alternative, the City could issue more limited restrictions on e-cig use.

To: Cecilia Mangoba/CTYATT@CTYATTCc: aragon@berkeley.edu, Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Rajiv Bhatia/DPH/SFGOV@SFGOV, Vickie Wells

<Vickie.Wells@sfdph.org>

Date: 01/13/2011 11:07 AM

Subject: Re: FW: Form to fill out re: electronic cigarettes

That is disappointing news.

Cecilia Mangoba/CTYATT@CTYATT

01/13/2011 11:01 AM

cc aragon@berkeley.edu, Audrey Lawrence<Audrey.Lawrence@flysfo.com>, Rajiv Bhatia/DPH/SFGOV@SFGOV,Vickie Wells <Vickie.Wells@sfdph.org>

Subject Re: FW: Form to fill out re: electronic cigarettesLink

Alyonik - I heard from the DOJ's attorney this morning that they lost that appeal. They've asked for a rehearing butI don't think we should be optimistic about a victory at this point.

To: Rajiv Bhatia/DPH/SFGOV@SFGOVCc: aragon@berkeley.edu, Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Cecilia Mangoba/CTYATT@CTYATT, Vickie Wells

<Vickie.Wells@sfdph.org>

Date: 01/13/2011 10:52 AM

Subject: Re: FW: Form to fill out re: electronic cigarettes

RajivI am hoping that the FDA's appeal will result in their abilitiy to ban e cigarettes. I don't see them as smokingcessation aides, rather as a way for smokers to be able to smoke in places where it is forbidden. And we don'treally know what is in these devices as the FDA is not regulating them. The state of CA has been sales of e cigs

to minors by the way.

Other than that, I don't think it's a good idea to open up the legislation to include e-cigarettes. It would be a hugebattle with small businesses again and it would also provide an opportunity for businesses to weaken our currentlegislation which took 5 years to adopt. It would be much easier if the airport promulgated their own policy.

01/13/2011 09:03 AM

cc aragon@berkeley.edu, Audrey Lawrence<Audrey.Lawrence@flysfo.com>, Cecilia Mangoba/CTYATT@CTYATT,Vickie Wells <Vickie.Wells@sfdph.org>

alyonik

i woud be interested in your opinions on tobacco control perspective on the pos and negative role of e-cigarettes

Alyonik Hrushow/DPH/SFGOV

01/13/2011 08:58 AM

To Rajiv Bhatia/DPH/SFGOV@SFGOV

cc Cecilia Mangoba/CTYATT@CTYATT, aragon@berkeley.edu, AudreyLawrence <Audrey.Lawrence@flysfo.com>, Vickie Wells<Vickie.Wells@sfdph.org>

There is very current info on the Technical Assistance Legal Center (TALC) on e cigarettes which includes adiscussion re how local governments can regulate e cigarettes (see link below).http://www.phlpnet.org/tobacco-control/question/what-latest-lawsuit-chall

According to TALC, a private business can adopt a policy banning e cigarettes. I would think that this would applyto a government agency as well. Additionally, local second hand smoke ordinances can include e cigs in theirdefinitions of smoking and ban e cig use that way. San Francisco recently adopted a more restrictive secondhand smoke ordinance but the ordinance does not cover e cigarettes. The ordinance was based on extensiveresearch findings re the hazards of second hand smoke while there is no combustion with e cigs. I don't believethat the sponsor of the second hand smoke ordinance would want to open up the ordinance for amendments atthis time.

Local tobacco permit ordinances can also regulate the sale of e cigs by requiring tobacco permits for their sale.

p g g y q g p

Our local ordinance does not do that.and TRLs can require permits for e cigs.

01/12/2011 08:49 AM

To Audrey Lawrence <Audrey.Lawrence@flysfo.com>, AlyonikHrushow/DPH/SFGOV@SFGOV, aragon@berkeley.edu

cc Vickie Wells <Vickie.Wells@sfdph.org>

Audrey,

I'm forwarding this to Tomas Aragon our new health officer. I don't think I should take an individual position hereand this would be a policy matter for the Commission. The Commission has strongly supported smoking preventionactivities so I think they would be interested in considering this.

I am also copying Alyonik Hrushow who plays a lead role in tobacco prevention efforts.

Audrey Lawrence <Audrey.Lawrence@flysfo.com>

01/12/2011 08:44 AM

To Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>

cc Vickie Wells <Vickie.Wells@sfdph.org>

Subject FW: Form to fill out re: electronic cigarettes

Dr. Bhatia,

Is anyone at DPH investigating the potential hazards of electronic cigarettes? I am trying torecommend an interim ban on the indoor use of electronic cigarettes. Our legal staff at SFOare hesitant to place a temporary ban on e cigarettes pending regulation from the FDA.

Would you be willing to support a temporary ruling on the indoor use of e cigarettes?

Manager of Safety and Health, Administration

P.O. Box 8097 | San Francisco 94128

Phone: 650-821-7889 | Fax: 650-821-5596

www.flysfo.com

September 23, 2010FDA Continues Fight to Regulate Electronic CigarettesThe Food and Drug Administration has authority to regulate so-called "electronic cigarettes" thatvaporize nicotine but do not contain tobacco, a Justice Department lawyer argued today in the U.S.Court of Appeals for the D.C. Circuit.Last year, a federal judge in Washington ruled the government improperly blocked an inboundshipment of e-cigarettes into the United States, saying that the FDA doesn’t have authority to regulatethe product because it is not marketed for therapeutic uses such as to treat smoking addiction.DOJ’s Alisa Klein of the Civil Division today tried to convince a three-judge appeals court panel toreverse the trial judge’s issuance of an injunction against the FDA. The appeals court stayedenforcement of the injunction pending resolution of the dispute.

Latham &Watkins partner Gregory Garre (at left), who chairs thefi ’ S C t d ll t ti t d S tt d l A b d S tt hi h

firm’s Supreme Court and appellate practice group, represented Scottsdale, Az.-based Sottera, whichsells e-cigarettes under the brand “NJOY.”E-cigarettes are battery-powered devices that resemble real cigarettes. The FDA blocked theimportation of e-cigarettes on the ground that they are unapproved drug devices under the federal Food,Drug and Cosmetic Act. Tobacco products are generally exempt from the drug and device provisionsof the FDCA.The Tobacco Control Act of 2009 gives the FDA authority to regulate “tobacco products,” a term thatwas closely scrutinized today by the appeals court panel consisting of Judges Merrick Garland andBrett Kavanaugh and Senior Judge Stephen Williams.Klein of the Justice Department said the FDA has long regulated nicotine products that includesmokeless cigarettes, nicotine lollipops and nicotine inhalers. In 2008, the FDA refused to allow theimportation of “Nicogel,” a hand gel made of liquefied tobacco. The FDA said the gel was anunapproved drug.“If electronic cigarettes are a safe method of nicotine maintenance, that could be approved if the sciencesupports it,” Klein said in court.Garland questioned what he called the “unique” procedural element of the case. The government’sposition in the litigation is established in a blocking order—stopping the shipment of electroniccigarettes—and not in a detailed administrative record. Kavanaugh and Williams examined the extent towhich Congress can step in to fill a regulatory void to clarify the scope of FDA regulatory authority.Garre, arguing for NJOY, said the product is not marketed as a smoking cessation device. He said if theFDA could show that the e-cigarettes are marketed for therapeutic reasons, the injunction against theFDA would not apply.Posted by Mike Scarcella on September 23, 2010 at 01:14 PM in Current Affairs, D.C. Courts andGovernment, Food and Drink, Justice Department , Politics and Government , Travel, Web/Tech |Perma

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Thu, Jan 13, 2011 at 11:19 AMTo: Cecilia Mangoba <Cecilia.Mangoba@sfgov.org>Cc: aragon@berkeley.edu, Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>,Vickie Wells <Vickie.Wells@sfdph.org>

Thanks for that info, Cecilia. I agree with you that we may not haveenough science about the health impacts which is something to considergiven what I would expect to be strong opposition from businesses.

Alyonik Hrushow/DPH/SFGOV@SFGOV01/13/2011 11:12 ccAM aragon@berkeley.edu, Audrey

YATT ToAlyonik Hrushow/DPH/SFGOV@SFGOV

01/13/2011 11:01 ccAM aragon@berkeley.edu, Audrey

aragon@berkeley.edu, AudreyLawrence<Audrey.Lawrence@flysfo.com>,Cecilia Mangoba/CTYATT@CTYATT,

Vickie Wells

<Vickie.Wells@sfdph.org>Subject

Re: FW: Form to fill out re:electronic cigarettes(Documentlink: Alyonik Hrushow)

alyonik

Audrey,

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Rajiv Bhatia <Rajiv.Bhatia@sfdph.org> Thu, Jan 13, 2011 at 12:40 PMTo: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>Cc: aragon@berkeley.edu, Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>, Vickie Wells <Vickie.Wells@sfdph.org>

thank you -- can FDA declare nicotine to be a drug?

aragon@berkeley.edu, AudreyLawrence<Audrey.Lawrence@flysfo.com>,Cecilia Mangoba/CTYATT@CTYATT,Vickie Wells<Vickie.Wells@sfdph.org>

pic18943.jpg7K

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Thu, Jan 13, 2011 at 1:32 PMTo: Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>Cc: aragon@berkeley.edu, Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>, Vickie Wells <Vickie.Wells@sfdph.org>

The FDA can regulate nicotine in products that are drugs or drug deliverydevices such as stop smoking aids. But the court of appeal held that ecigs are not marketed as cessation devices and that the FDA does haveauthority over e cigarettes as a drug or delivery device. The FDA hasauthority regulate tobacco products as prescribed in the 2009 FamilySmoking Prevention andn Tobacco Control Act, which Philip Morris helpedcraft by the way. I don't believe e cigarettes can be regulated by FDAunde this piece of legislation.

To01/13/2011 12:40 Alyonik Hrushow/DPH/SFGOV@SFGOV

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Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Fri, Jan 14, 2011 at 8:13 AMTo: Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>Cc: aragon@berkeley.edu, Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>, Vickie Wells <Vickie.Wells@sfdph.org>

__________________

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Tomas Aragon <tomas aragon@sfdph org> Mon Jan 17 2011 at 9:59 PM

Tomas Aragon <tomas.aragon@sfdph.org> Mon, Jan 17, 2011 at 9:59 PM

To: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>Cc: Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>, Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>, Vickie Wells <Vickie.Wells@sfdph.org>

Alyonik, Can we organize a meeting to review this topic?* Is nicotine a drug? (yes)* Does e-cigs result in vaporized nicotine that is involuntary inhaled by bystanders? (?yes)* Does inhaled vaporized nicotine alone cause adverse physiologic responses? (yes: coronary arteryvasoconstriction, bronchospasm, etc.)* What are the other toxicants / chemicals in e-cig vapors?

If the first three bullets are yes, then I think SFO has sufficient reason to ban e-cigs to prevent the involuntaryexposure to nicotine with know adverse pharmacological effects.

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Tue, Jan 18, 2011 at 11:00 AMTo: Tomas Aragon <tomas.aragon@sfdph.org>

TomasSee attached document that responds to your request. Let me know whatchanges you would like to make.

(See attached file: MtgReECigs.docx)

ccRajiv Bhatia

01/17/2011 09:59 <Rajiv.Bhatia@sfdph.org>, Audrey

PM Lawrence

<Audrey.Lawrence@flysfo.com>,Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>, Vickie

MtgReECigs.docx13K

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Thu, Jan 20, 2011 at 2:36 PMTo: Tomas Aragon <tomas.aragon@sfdph.org>Cc: Audrey Lawrence <Audrey.Lawrence@flysfo.com>, Cecilia Mangoba <Cecilia.Mangoba@sfgov.org>,medepi@gmail.com, Rajiv Bhatia <Rajiv.Bhatia@sfdph.org>, Vickie Wells <Vickie.Wells@sfdph.org>

I would suggest the following stakeholders participate in a meeting:

Tomas Aragon, Director Population Health and PreventionRajiv Bhatia, Director of Environmental HealthAlyonik Hrushow, Tobacco Free Project DirectorJanine Young, Senior Environmental Health Inspector enforcing SanFrancisco's second hand smoke ordinanceAudrey Lawrence, Manager of Safety and Health, SFO

Pre-Meeting Key Tasks and suggestions re who could conduct tasks

Compile information on:

1. Background info re e cigarettes - what they are, how they are marketed -Alyonik Hrushow2. Issues around e cigarettes at SFO - Audrey Lawrence3. Health risks of e cigarettes - Alyonik Hrushow4. Implications for second hand smoke ordinance - Janine Young and AlyonikHrushow5. Legal authority and legal actions taken - Alyonik Hrushow6. Bans on e cigarettes adopted by other govt. bodies and rationales used -Alyonik Hrushow7. Options for banning e cigarettes in SF - Cecilia Mangoba and AlyonikHrushow

Attached is a draft agenda.(See attached file: DraftMtgAgenda.docx)

I have gathered info for Pre-Meeting Tasks 1, and 3-7 which are compiled inthe attached draft brief. Cecilia Mangoba Deputy CityAttorney hasd already reviewed the document and I have incorporated hersuggestions. I will ask Janine Young to review #4, Implications for SanFrancisco's second hand smoke ordinance. She is out ot the office untilJanl 24. Perhaps Audrey Lawrence can fill in the section I left blank reissues around e cigarettes for the airport.

(See attached file: ECigBrief1.20.11Draft.docx)

Finally, the following link will take you to a David Letterman segment witha guest demonstrating an e cigarette and touting it as a safer alternativeto traditional cigarettes

http://www.weeklyhealthusa.org/latest/articles/breakthroughdiet/adb/us4/

ccRajiv Bhatia

<Audrey.Lawrence@flysfo.com>,Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>, Vickie

2 attachments

DraftMtgAgenda.docx10K

ECigBrief1.20.11Draft.docx79K

Meeting re: electronic cigarettes7 messages

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Tue, Feb 1, 2011 at 1:10 PMTo: tomas.aragon@sfdph.org

TomasJust wanted to follow up on my Jan. 20 email below. Have been contacted byAleeta and Audrey Lawrence from the Airport asking if a meeting has beenplanned yet.

Alyonik HrushowSan Francisco Tobacco Free Project----- Forwarded by Alyonik Hrushow/DPH/SFGOV on 02/01/2011 01:10 PM -----

To01/20/2011 02:36 Tomas AragonPM <tomas.aragon@sfdph.org>

ccAudrey Lawrence<Audrey.Lawrence@flysfo.com>,Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>,medepi@gmail.com, Rajiv Bhatia<Rajiv.Bhatia@sfdph.org>, VickieWells <Vickie.Wells@sfdph.org>

I would suggest the following stakeholders participate in a meeting:

Tomas Aragon, Director Population Health and PreventionRajiv Bhatia, Director of Environmental HealthAlyonik Hrushow, Tobacco Free Project DirectorJanine Young, Senior Environmental Health Inspector enforcing San

g p gFrancisco's second hand smoke ordinanceAudrey Lawrence, Manager of Safety and Health, SFO

Pre-Meeting Key Tasks and suggestions re who could conduct tasks

Compile information on:

1. Background info re e cigarettes - what they are, how they are marketed -Alyonik Hrushow2. Issues around e cigarettes at SFO - Audrey Lawrence3. Health risks of e cigarettes - Alyonik Hrushow4. Implications for second hand smoke ordinance - Janine Young and AlyonikHrushow5. Legal authority and legal actions taken - Alyonik Hrushow6. Bans on e cigarettes adopted by other govt. bodies and rationales used -Alyonik Hrushow7. Options for banning e cigarettes in SF - Cecilia Mangoba and AlyonikHrushow

Attached is a draft agenda.(See attached file: DraftMtgAgenda.docx)

I have gathered info for Pre-Meeting Tasks 1, and 3-7 which are compiled inthe attached draft brief. Cecilia Mangoba Deputy CityAttorney hasd already reviewed the document and I have incorporated hersuggestions. I will ask Janine Young to review #4, Implications for SanFrancisco's second hand smoke ordinance. She is out ot the office untilJanl 24. Perhaps Audrey Lawrence can fill in the section I left blank reissues around e cigarettes for the airport.

(See attached file: ECigBrief1.20.11Draft.docx)

Finally, the following link will take you to a David Letterman segment witha guest demonstrating an e cigarette and touting it as a safer alternativeto traditional cigarettes

http://www.weeklyhealthusa.org/latest/articles/breakthroughdiet/adb/us4/

ccRajiv Bhatia

<Audrey.Lawrence@flysfo.com>,Cecilia Mangoba<Cecilia.Mangoba@sfgov.org>, VickieWells <Vickie.Wells@sfdph.org>

SubjectRe: FW: Form to fill out re:electronic cigarettes

Alyonik, Can we organize a meeting to review this topic?* Is nicotine a drug? (yes)* Does e-cigs result in vaporized nicotine that is involuntary inhaled bybystanders? (?yes)* Does inhaled vaporized nicotine alone cause adverse physiologicresponses? (yes: coronary artery vasoconstriction, bronchospasm, etc.)* What are the other toxicants / chemicals in e-cig vapors?

If the first three bullets are yes, then I think SFO has sufficient reasonto ban e-cigs to prevent the involuntary exposure to nicotine with knowadverse pharmacological effects.

On Fri, Jan 14, 2011 at 8:13 AM, Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> wrote:

__________________

Alyonik HrushowSan Francisco Tobacco Free Project RajivBhatia/DPH/SFGOV To01/13/2011 12:40 Alyonik Hrushow/DPH/SFGOV@SFGOVPMcc aragon@berkeley.edu,AudreyLawrence <Audrey.Lawrence@flysfo.com>, CeciliaMangoba/CTYATT@CTYATT, VickieWells <Vickie.Wells@sfdph.org>Subject Re: FW: Form to fill outre: electroniccigarettes(Document link: AlyonikHrushow)

thank you -- can FDA declare nicotine to be a drug?AlyonikHrushow/DPH/SFGOV To01/13/2011 11:02 Rajiv Bhatia/DPH/SFGOV@SFGOVAMcc aragon@berkeley.edu,AudreyLawrence <Audrey.Lawrence@flysfo.com>, CeciliaMangoba/CTYATT@CTYATT, VickieWells <Vickie.Wells@sfdph.org>Subject Re: FW: Form to fill outre: electroniccigarettes(Document link: RajivBhatia)

Alyonik HrushowSan Francisco Tobacco Free Project RajivBhatia/DPH/SFGOV To01/13/2011 09:03 Alyonik Hrushow/DPH/SFGOV@SFGOVAMcc aragon@berkeley.edu,AudreyLawrence <Audrey.Lawrence@flysfo.com>, CeciliaMangoba/CTYATT@CTYATT, VickieWells <Vickie.Wells@sfdph.org>Subject Re: FW: Form to fill outre: electroniccigarettes(Document link: AlyonikHrushow)

alyonik

i woud be interested in your opinions on tobacco control perspective onthepos and negative role of e-cigarettes

rajiv AlyonikHrushow/DPH/SFGOV To01/13/2011 08:58 Rajiv Bhatia/DPH/SFGOV@SFGOVAMcc CeciliaMangoba/CTYATT@CTYATT,aragon@berkeley.edu, AudreyLawrence <Audrey.Lawrence@flysfo.com>, VickieWells <Vickie.Wells@sfdph.org>Subject Re: FW: Form to fill outre: electronic

re: electroniccigarettes(Document link: RajivBhatia)

There is very current info on the Technical Assistance Legal Center(TALC)on e cigarettes which includes a discussion re how local governments canregulate e cigarettes (see link below).http://www.phlpnet.org/tobacco-control/question/what-latest-lawsuit-chall

According to TALC, a private business can adopt a policy banning ecigarettes. I would think that this would apply to a government agencyaswell. Additionally, local second hand smoke ordinances can include ecigs in their definitions of smoking and ban e cig use that way. SanFrancisco recently adopted a more restrictive second hand smoke ordinancebut the ordinance does not cover e cigarettes. The ordinance was basedonextensive research findings re the hazards of second hand smoke whilethereis no combustion with e cigs. I don't believe that the sponsor of thesecond hand smoke ordinance would want to open up the ordinance foramendments at this time.

Local tobacco permit ordinances can also regulate the sale of e cigs byrequiring tobacco permits for their sale. Our local ordinance does notdothat. and TRLs can require permits for e cigs.

Alyonik HrushowSan Francisco Tobacco Free Project RajivBhatia/DPH/SFGOV To01/12/2011 08:49 Audrey LawrenceAM <Audrey.Lawrence@flysfo.com>, AlyonikHrushow/DPH/SFGOV@SFGOV,aragon@berkeley.edu

cc VickieWells <Vickie.Wells@sfdph.org>Subject Re: FW: Form to fill outre: electroniccigarettes(Document link: AlyonikHrushow)

Audrey,

I'm forwarding this to Tomas Aragon our new health officer. I don't thinkIshould take an individual position here and this would be a policy matterfor the Commission. The Commission has strongly supported smokingprevention activities so I think they would be interested in consideringthis.

rajiv Audrey Lawrence <Audrey.Lawrence@flysfo.com> ToRajiv Bhatia 01/12/2011 08:44 <Rajiv.Bhatia@sfdph.org>AMcc VickieWells <Vickie.Wells@sfdph.org>Subject FW: Form to fill out re:electronic cigarettes -| ||-|| ||-|

Dr. Bhatia,

Thank you for your time and assistance on this issue. Audrey Lawrence,MPH CIH | S.F. International A irport Manager of Safety and Health,Administration ------------------------------------------------

Administration ------------------------------------------------|P.O. Box 8097 | San Francisco 94128 ||------------------------------------------------||Phone: 650-821-7889 | Fax: 650-821-5596 ||------------------------------------------------| www.flysfo.com

September 23, 2010FDA Continues Fight to Regulate Electronic CigarettesThe Food and Drug Administration has authority to regulate so-called"electronic cigarettes" that vaporize nicotine but do not containtobacco,a Justice Department lawyer argued today in the U.S. Court of Appeals forthe D.C. Circuit.Last year, a federal judge in Washington ruled the government improperlyblocked an inbound shipment of e-cigarettes into the United States,sayingthat the FDA doesn’t have authority to regulate the product because it isnot marketed for therapeutic uses such as to treat smoking addiction.DOJ’s Alisa Klein of the Civil Division today tried to convince athree-judge appeals court panel to reverse the trial judge’s issuance ofaninjunction against the FDA. The appeals court stayed enforcement of theinjunction pending resolution of the dispute.(Embedded image moved to file: pic09735.jpg)Garre_gregory_kagan_#3056D6Latham & Watkins partner Gregory Garre (at left), who chairs the firm’sSupreme Court and appellate practice group, represented Scottsdale,Az.-based Sottera, which sells e-cigarettes under the brand “NJOY.”E-cigarettes are battery-powered devices that resemble real cigarettes.TheFDA blocked the importation of e-cigarettes on the ground that they areunapproved drug devices under the federal Food, Drug and Cosmetic Act.Tobacco products are generally exempt from the drug and device provisionsof the FDCA.The Tobacco Control Act of 2009 gives the FDA authority to regulate“tobacco products,” a term that was closely scrutinized today by theappeals court panel consisting of Judges Merrick Garland and BrettKavanaugh and Senior Judge Stephen Williams.Klein of the Justice Department said the FDA has long regulated nicotineproducts that include smokeless cigarettes, nicotine lollipops andnicotineinhalers. In 2008, the FDA refused to allow the importation of “Nicogel,”ahand gel made of liquefied tobacco. The FDA said the gel was anunapproveddrug.“If electronic cigarettes are a safe method of nicotine maintenance, thatcould be approved if the science supports it,” Klein said in court.Garland questioned what he called the “unique” procedural element of thecase The government’s position in the litigation is established in a

case. The government s position in the litigation is established in ablocking order—stopping the shipment of electronic cigarettes—and not inadetailed administrative record. Kavanaugh and Williams examined theextentto which Congress can step in to fill a regulatory void to clarify thescope of FDA regulatory authority.Garre, arguing for NJOY, said the product is not marketed as a smokingcessation device. He said if the FDA could show that the e-cigarettes aremarketed for therapeutic reasons, the injunction against the FDA wouldnotapply.Posted by Mike Scarcella on September 23, 2010 at 01:14 PM in CurrentAffairs, D.C. Courts and Government, Food and Drink, Justice Department ,Politics and Government , Travel, Web/Tech | Perma [attachment "Exec ComPolicy Form E Cigarettes.docx" deleted by RajivBhatia/DPH/SFGOV]

2 attachments

DraftMtgAgenda.docx10K

ECigBrief1.20.11Draft.docx79K

Tomas Aragon <tomas.aragon@sfdph.org> Tue, Feb 1, 2011 at 1:50 PMTo: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>Cc: tomas.aragon@sfdph.org

Alyonik, please give me a call.Thx

=======Tomas Aragon, MD, DrPH (in the field)Health Officer, SF Dept of Public HealthG-Phone: 415-78-SALUD (415-787-2583)

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Tue, Feb 1, 2011 at 2:49 PMTo: Tomas Aragon <tomas.aragon@sfdph.org>Cc: medepi@gmail.com, tomas.aragon@sfdph.org

TomasLet me know which of the following dates/times would work for you and Iwill send out a doodle survey.

Also, do you want someone from the City Attorney's office to attend?If we are all city employees, she could provide us with legal expertiseand maintain the client attorney privelege All the stakeholders on my

and maintain the client attorney privelege. All the stakeholders on my

suggested list are city employees.

Mon. 2/14 pmTues. 2/15 pmWed. 2/16 pmMon 2/28 pmTues. 3/1 pmWed. 3/2 pmTh. 3/3 pmFri. 3/4 am

cctomas.aragon@sfdph.org

02/01/2011 01:50 SubjectPM Re: Meeting re: electronic

cigarettes

Tomas Aragon <tomas.aragon@sfdph.org> Tue, Feb 1, 2011 at 11:51 PMTo: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>

Mon. 2/14 pm -- after 2pmTues. 2/15 pm -- betw 2:30p-4pWed. 2/16 pm -- betw 1p-4pMon 2/28 pm -- after 2pmTues. 3/1 pm -- after 1pmWed. 3/2 pm -- after 1pmTh. 3/3 pm -- after 1pmFri. 3/4 am -- 9am-1pm

Thanks!

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Wed, Feb 2, 2011 at 8:24 AMTo: Tomas Aragon <tomas.aragon@sfdph.org>

TomasDo you want to invite Aleeta from City Attornye's office?

02/01/2011 11:51 Subject

Tomas Aragon <tomas.aragon@sfdph.org> Wed, Feb 2, 2011 at 8:53 AMTo: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>

Yes, her or a rep.

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Wed, Feb 2, 2011 at 8:59 AMTo: Tomas Aragon <tomas.aragon@sfdph.org>

Thanks

Tomas Aragon

<tomas.aragon@sfdph.org> ToSent by: Alyonik Hrushowmedepi@gmail.com <Alyonik.Hrushow@sfdph.org>

02/02/2011 08:53 Subject

Set mtg.re electronic cigarettes Mon. 2/14, 2-3:30 or Wed.3/2, 1-2:30pm?3 messages

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Thu, Feb 3, 2011 at 12:08 PMTo: Tomas Aragon <tomas.aragon@sfdph.org>

TomasEveryone can make it on either Monday, Feb. 14, 2-3:30pm or Wed. March 2,1:00-2:30pm.Please let me know which date you choose, where you would like to meet. Wehave a meeting room at 30 Van Ness, Suite 2300 available..

I will send out a meeting announcement once I hear from you.

02/02/2011 08:53 SubjectAM Re: Meeting re: electronic

cigarettes

Yes, her or a rep.

=======Tomás J. Aragón, MD, DrPH, Health OfficerDirector, Population Health & PreventionSan Francisco Department of Public Health

101 Grove St, Rm 308, SF CA 94102-4505G-Phone: 415-78-SALUD (415-787-2583)

On Wed, Feb 2, 2011 at 8:24 AM, Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>wrote:TomasDo you want to invite Aleeta from City Attornye's office?

Alyonik HrushowSan Francisco Tobacco Free Project Tomas Aragon<tomas.aragon@sfd ph.org> To Sentby: Alyonik Hrushow medepi@gmail.com<Alyonik.Hrushow@sfdph.org> cc

02/01/2011 11:51 SubjectPM Re: Meeting re:

electronic cigarettes

Mon. 2/14 pm -- after 2pmTues. 2/15 pm -- betw 2:30p-4pWed. 2/16 pm -- betw 1p-4pMon 2/28 pm -- after 2pmTues. 3/1 pm -- after 1pmWed. 3/2 pm -- after 1pmTh. 3/3 pm -- after 1pmFri. 3/4 am -- 9am-1pm

Thanks!

On Tue, Feb 1, 2011 at 2:49 PM, Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>wrote: Tomas Let me know which of the following dates/times would workfor you and I will send out a doodle survey. Also, do you want someonefrom the City Attorney's office to attend? If we are all city employees,she could provide us with legal expertise and maintain the clientattorney privelege. All the stakeholders on my suggested list are cityemployees. Mon. 2/14 pm Tues. 2/15 pm Wed. 2/16 pm Mon 2/28 pm Tues.3/1 pm Wed. 3/2 pm Th. 3/3 pm Fri. 3/4 am Alyonik Hrushow SanFrancisco Tobacco Free Project TomasAragon <tomas.aragon@sfd ph.org> ToSent by: Alyonik Hrushow medepi@gmail.com<Alyonik.Hrushow@sfdph.org

tomas.aragon@sfdph.org

02/01/2011 01:50 Subject PM Re:Meeting re: electroniccigarettes Alyonik, please give me a call. Thx ======= Tomas Aragon, MD,DrPH (in the field) Health Officer, SF Dept of Public Health G-Phone:415-78-SALUD (415-787-2583) On Feb 1, 2011 1:12 PM, "Alyonik Hrushow" <Alyonik.Hrushow@sfdph.org> wrote: > > Tomas > Just wanted to follow up onmy Jan. 20 email below. Have been contacted by > Aleeta and AudreyLawrence from the Airport asking if a meeting has been > planned yet. > >Alyonik Hrushow > San Francisco Tobacco Free Project > ----- Forwarded byAlyonik Hrushow/DPH/SFGOV on 02/01/2011 01:10 PM ----- > > Alyonik >Hrushow/DPH/SFGOV > To > 01/20/2011 02:36 Tomas Aragon > PM <tomas.aragon@sfdph.org> > cc > Audrey Lawrence > <Audrey.Lawrence@flysfo.com>, > Cecilia Mangoba > <Cecilia.Mangoba@sfgov.org>, > medepi@gmail.com, Rajiv Bhatia > <Rajiv.Bhatia@sfdph.org>, Vickie > Wells <Vickie.Wells@sfdph.org> >Subject > Re: FW: Form to fill out re: > electronic cigarettes(Document >link: Alyonik Hrushow) > > > > > > > > > > Tomas > > I would suggest thefollowing stakeholders participate in a meeting: > > Tomas Aragon,Director Population Health and Prevention > Rajiv Bhatia, Director ofEnvironmental Health > Alyonik Hrushow, Tobacco Free Project Director >Janine Young, Senior Environmental Health Inspector enforcing San >Francisco's second hand smoke ordinance > Audrey Lawrence, Manager ofSafety and Health, SFO > > Pre-Meeting Key Tasks and suggestions re whocould conduct tasks > > Compile information on: > > 1. Background info ree cigarettes - what they are, how they are marketed - > Alyonik Hrushow >2. Issues around e cigarettes at SFO - Audrey Lawrence > 3. Health risksof e cigarettes - Alyonik Hrushow > 4. Implications for second hand smokeordinance - Janine Young and Alyonik > Hrushow > 5. Legal authority andlegal actions taken - Alyonik Hrushow > 6. Bans on e cigarettes adoptedby other govt. bodies and rationales used - > Alyonik Hrushow > 7.Options for banning e cigarettes in SF - Cecilia Mangoba and Alyonik >Hrushow > > Attached is a draft agenda. > (See attached file:DraftMtgAgenda.docx) > > I have gathered info for Pre-Meeting Tasks 1,and 3-7 which are compiled in > the attached draft brief. Cecilia MangobaDeputy City > Attorney hasd already reviewed the document and I haveincorporated her > suggestions. I will ask Janine Young to review #4,

p gg g ,Implications for San > Francisco's second hand smoke ordinance. She isout ot the office until > Janl 24. Perhaps Audrey Lawrence can fill inthe section I left blank re > issues around e cigarettes for theairport. > > (See attached file: ECigBrief1.20.11Draft.docx) > > >Finally, the following link will take you to a David Lettermansegment with > a guest demonstrating an e cigarette and touting it as asafer alternative > to traditional cigarettes > > >http://www.weeklyhealthusa.org/latest/articles/breakthroughdiet/adb/us4/> > > Alyonik Hrushow > San Francisco Tobacco Free Project > > > > TomasAragon > <tomas.aragon@sfd > ph.org> To > Sent by: Alyonik Hrushow >medepi@gmail.com <Alyonik.Hrushow@sfdph.org> > cc > Rajiv Bhatia >01/17/2011 09:59 <Rajiv.Bhatia@sfdph.org>, Audrey > PM Lawrence > <Audrey.Lawrence@flysfo.com>, > Cecilia Mangoba > <Cecilia.Mangoba@sfgov.org>, Vickie > Wells <Vickie.Wells@sfdph.org> >Subject > Re: FW: Form to fill out re: > electroniccigarettes > > > > > > > > > > > Alyonik, Can we organize a meeting toreview this topic? > * Is nicotine a drug? (yes) > * Does e-cigs resultin vaporized nicotine that is involuntary inhaled by > bystanders?(?yes) > * Does inhaled vaporized nicotine alone cause adversephysiologic > responses? (yes: coronary artery vasoconstriction,bronchospasm, etc.) > * What are the other toxicants / chemicals in e-cigvapors? > > If the first three bullets are yes, then I think SFO hassufficient reason > to ban e-cigs to prevent the involuntary exposure tonicotine with know > adverse pharmacological effects. > > Can you: > *identify key stakeholders to attend > * prepare draft agenda > * identifypre-meeting key tasks (and suggest who can do them) > > Then, we canschedule. > > Tomas > > ======= > Tomás J. Aragón, MD, DrPH, HealthOfficer > Director, Population Health & Prevention > San FranciscoDepartment of Public Health > 101 Grove St, Rm 308, SF CA 94102-4505 >G-Phone: 415-78-SALUD (415-787-2583) > > > On Fri, Jan 14, 2011 at 8:13AM, Alyonik Hrushow < Alyonik.Hrushow@sfdph.org>> wrote: > > Rajiv > Cecilia just alerted me that I omitted the wordnot below in my original > email, which completely changes the meaning ofthe sentence. > Alyonik Hrushow > San Francisco Tobacco Free Project > >__________________ > > The FDA can regulate nicotine in products that aredrugs or drug delivery > devices such as stop smoking aids. But thecourt of appeal held that e > cigs are not marketed as cessation devicesand that the FDA does not have > authority over e cigarettes as a drug ordelivery device. The FDA has > authority regulate tobacco products asprescribed in the 2009 Family > Smoking Prevention and Tobacco ControlAct, which Philip Morris helped > craft by the way. I don't believe ecigarettes can be regulated by FDA > under this piece of legislation. > >Alyonik Hrushow > San Francisco Tobacco Free ProjectRajiv > Bhatia/DPH/SFGOV To >01/13/2011 12:40 Alyonik Hrushow/DPH/SFGOV@SFGOV > PM >cc aragon@berkeley.edu, > Audrey >Lawrence <Audrey.Lawrence@flysfo.com> >, Cecilia >Mangoba/CTYATT@CTYATT, Vickie >Wells <Vickie.Wells@sfdph.org> > > Subject Re: FW: Form to fillout > re: electronic >cigarettes(Document link: Alyonik >Hrushow) > > > > > > > > > > thank you -- can FDA declare nicotine to be

us o ) t a you ca dec a e cot e to bea drug? >Alyonik > Hrushow/DPH/SFGOV To >01/13/2011 11:02 Rajiv Bhatia/DPH/SFGOV@SFGOV > AM >cc aragon@berkeley.edu, > Audrey >Lawrence <Audrey.Lawrence@flysfo.com> >, Cecilia >Mangoba/CTYATT@CTYATT, Vickie >Wells <Vickie.Wells@sfdph.org> > > Subject Re: FW: Form to fillout > re: electronic >cigarettes(Document link: Rajiv >Bhatia) > > > > > > > > > > Rajiv > Here is info from the FDA repotential risks of e cigarettes. > >http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM173430.pdf> > Alyonik Hrushow > San Francisco Tobacco Free ProjectRajiv > Bhatia/DPH/SFGOV To >01/13/2011 09:03 Alyonik Hrushow/DPH/SFGOV@SFGOV > AM >cc aragon@berkeley.edu, > Audrey >Lawrence <Audrey.Lawrence@flysfo.com> >, Cecilia >Mangoba/CTYATT@CTYATT, Vickie >Wells <Vickie.Wells@sfdph.org> > > Subject Re: FW: Form to fillout > re: electronic >cigarettes(Document link: Alyonik >Hrushow) > > > > > > > > > > alyonik > > i woud be interested in youropinions on tobacco control perspective on > the > pos and negative roleof e-cigarettes > > rajivAlyonik > Hrushow/DPH/SFGOV To >01/13/2011 08:58 Rajiv Bhatia/DPH/SFGOV@SFGOV > AM >cc Cecilia >Mangoba/CTYATT@CTYATT, > aragon@berkeley.edu, Audrey >Lawrence <Audrey.Lawrence@flysfo.com> >, Vickie >Wells <Vickie.Wells@sfdph.org> > > Subject Re: FW: Form to fillout > re: electronic >cigarettes(Document link: Rajiv >Bhatia) > > > > > > > > > > Rajiv, Tomas and Audrey, > > There is verycurrent info on the Technical Assistance Legal Center > (TALC) > on ecigarettes which includes a discussion re how local governments can >regulate e cigarettes (see link below). >http://www.phlpnet.org/tobacco-control/question/what-latest-lawsuit-chall> > According to TALC, a private business can adopt a policy banning e >cigarettes. I would think that this would apply to a government agency >as > well. Additionally, local second hand smoke ordinances can includee > cigs in their definitions of smoking and ban e cig use that way.San > Francisco recently adopted a more restrictive second handsmoke ordinance > but the ordinance does not cover e cigarettes. Theordinance was based > on > extensive research findings re the hazards ofsecond hand smoke while > there > is no combustion with e cigs. I don'tbelieve that the sponsor of the > second hand smoke ordinance would want

believe that the sponsor of the second hand smoke ordinance would wantto open up the ordinance for > amendments at this time. > > Local tobaccopermit ordinances can also regulate the sale of e cigs by > requiringtobacco permits for their sale. Our local ordinance does not > do >that. and TRLs can require permits for e cigs. > > Alyonik Hrushow > SanFrancisco Tobacco Free ProjectRajiv > Bhatia/DPH/SFGOV To >01/12/2011 08:49 Audrey Lawrence > AM <Audrey.Lawrence@flysfo.com> >, Alyonik >Hrushow/DPH/SFGOV@SFGOV, > aragon@berkeley.edu> > cc Vickie >Wells <Vickie.Wells@sfdph.org> > > Subject Re: FW: Form to fillout > re: electronic >cigarettes(Document link: Alyonik >Hrushow) > > > > > > > > > > Audrey, > > I'm forwarding this to TomasAragon our new health officer. I don't think > I > should take anindividual position here and this would be a policy matter > for theCommission. The Commission has strongly supported smoking > preventionactivities so I think they would be interested in considering > this. > >I am also copying Alyonik Hrushow who plays a lead role in tobacco >prevention efforts. > > rajiv Audrey Lawrence<Audrey.Lawrence@ > flysfo.com

> > To >Rajiv Bhatia 01/12/2011 08:44 < >Rajiv.Bhatia@sfdph.org> > AM > ccVickie > Wells <Vickie.Wells@sfdph.org> > > Subject FW: Form to fill outre: > electronic cigarettes - > || > |-| > | | > |-| > > > > > > > > Dr. Bhatia, > > Is anyone at DPHinvestigating the potential hazards of electronic > cigarettes? I amtrying to recommend an interim ban on the indoor use of > electroniccigarettes. Our legal staff at SFO are hesitant to place a > temporaryban on e cigarettes pending regulation from the FDA. > > Would you bewilling to support a temporary ruling on the indoor use of e >cigarettes? > > Thank you for your time and assistance on thisissue. Audrey Lawrence, > MPH CIH | S.F. InternationalA irport Manager of Safety and Health, >Administration ------------------------------------------------ > |P.O.Box 8097 | San Francisco 94128 | >|------------------------------------------------| > |Phone: 650-821-7889| Fax: 650-821-5596 | >|------------------------------------------------| www.flysfo.com> > > > > > > > > September 23, 2010 > FDA Continues Fight to RegulateElectronic Cigarettes > The Food and Drug Administration has authority toregulate so-called > "electronic cigarettes" that vaporize nicotine butdo not contain > tobacco, > a Justice Department lawyer argued today inthe U.S. Court of Appeals for > the D.C. Circuit. > Last year, a federaljudge in Washington ruled the government improperly > blocked an inboundshipment of e-cigarettes into the United States, > saying > that the FDAdoesn’t have authority to regulate the product because it is > notmarketed for therapeutic uses such as to treat smoking addiction. > DOJ’sAlisa Klein of the Civil Division today tried to convince a > three-judge

Alisa Klein of the Civil Division today tried to convince a > three judgeappeals court panel to reverse the trial judge’s issuance of > an >injunction against the FDA. The appeals court stayed enforcement of the >injunction pending resolution of the dispute. > (Embedded image moved tofile: pic09735.jpg)Garre_gregory_kagan_#3056D6 > Latham & Watkins partnerGregory Garre (at left), who chairs the firm’s > Supreme Court andappellate practice group, represented Scottsdale, > Az.-based Sottera,which sells e-cigarettes under the brand “NJOY.” > E-cigarettes arebattery-powered devices that resemble real cigarettes. > The > FDAblocked the importation of e-cigarettes on the ground that they are >unapproved drug devices under the federal Food, Drug and Cosmetic Act. >Tobacco products are generally exempt from the drug anddevice provisions > of the FDCA. > The Tobacco Control Act of 2009 givesthe FDA authority to regulate > “tobacco products,” a term that wasclosely scrutinized today by the > appeals court panel consisting ofJudges Merrick Garland and Brett > Kavanaugh and Senior Judge StephenWilliams. > Klein of the Justice Department said the FDA has longregulated nicotine > products that include smokeless cigarettes, nicotinelollipops and > nicotine > inhalers. In 2008, the FDA refused to allowthe importation of “Nicogel,” > a > hand gel made of liquefied tobacco.The FDA said the gel was an > unapproved > drug. > “If electroniccigarettes are a safe method of nicotine maintenance, that > could beapproved if the science supports it,” Klein said in court. > Garlandquestioned what he called the “unique” procedural element of the > case.The government’s position in the litigation is established in a >blocking order—stopping the shipment of electronic cigarettes—andnot in > a > detailed administrative record. Kavanaugh and Williamsexamined the > extent > to which Congress can step in to fill aregulatory void to clarify the > scope of FDA regulatory authority. >Garre, arguing for NJOY, said the product is not marketed as a smoking >cessation device. He said if the FDA could show that thee-cigarettes are > marketed for therapeutic reasons, the injunctionagainst the FDA would > not > apply. > Posted by Mike Scarcella onSeptember 23, 2010 at 01:14 PM in Current > Affairs, D.C. Courts andGovernment, Food and Drink, Justice Department , > Politics andGovernment , Travel, Web/Tech | Perma [attachment "Exec Com > PolicyForm E Cigarettes.docx" deleted by Rajiv > Bhatia/DPH/SFGOV] > > > >

Tomas Aragon <tomas.aragon@sfdph.org> Fri, Feb 4, 2011 at 12:11 PMTo: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>

Let's meet Wed. March 2, 1:00-2:30pm.

Your location is fine.

Thanks!

=======Tomás J. Aragón, MD, DrPH, Health Officer

Director, Population Health & PreventionSan Francisco Department of Public Health101 Grove St, Rm 308, SF CA 94102-4505G-Phone: 415-78-SALUD (415-787-2583)

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Fri, Feb 4, 2011 at 1:10 PMTo: Tomas Aragon <tomas.aragon@sfdph.org>

Thanks, I will send out the announcement.

02/04/2011 12:11 SubjectPM Re: Set mtg.re electronic

cigarettes Mon. 2/14, 2-3:30 orWed. 3/2, 1-2:30pm?

follow up to E cig meeting1 message

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Tue, Mar 8, 2011 at 9:26 AMTo: tomas.aragon@sfdph.org, rajiv.bhatia@sfdph.org, Audrey.Lawrence@flysfo.com, Janine Young<Janine.Young@sfdph.org>, Cecilia Mangoba <Cecilia.Mangoba@sfgov.org>Cc: Tom Rivard <Tom.Rivard@sfdph.org>

Hi All

As a follow up to our meeting re a proposed policy to regulate Ecigarettes, I have prepared the attached 2 page policy proposal and a draftaction plan.

I think that the SF Tobacco Free Coalition will want to support thisinitiative, but don't think they can take the lead given the othercompeting campaigns they have committed to that are part of our 3 yearplan. I think that Tomas, Rajiv and Airport folks would have the strongestinfluence on the supervisors as well as the Small Business Commission andshould take the lead on the critical ones as well as seeking theirendorsements. We have Coalition members from the American Cancer Society,American Heart Association, American Lung Association, SF Medical Society,BREATHE California and I can gather their endorsements.

The Tobacco Free Project might have some funds to pay a media consultant towork on the outlined media tasks, but this will depend on what funds areavailable for media once the costs of our media campaign for our smokefree housing objective are finalized.

I did not insert timelines for most of the activities as this will be afluid process. Many supervisors won't want to take a position until theyhear what concerns the Small Business Commission has, or may not takepositions until after a committee hearing takes place.

Please provide any feedback.

Tomas, please let me know how you would like to proceed and any revisionsyou would like on the attached documents.(See attached file: ECigPolicyProposal.doc)(See attached file: actionplan.doc)

2 attachments

ECigPolicyProposal.doc96K

action plan.doc

Follow up to E cig meeting1 message

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Tue, Apr 5, 2011 at 12:32 PMTo: tomas.aragon@sfdph.org

Hi TomasHope you had a relaxing vacation last week.

Just wanted to follow up on the email and documents I sent out on 3/8 afterour meeting re E cigarettes. Audrey Lawrence from the airport was askingif there was any update.

Also, wondered if you had had a chance to call Human Resource re thePrevention Director position.

__________________

Hi All

As a follow up to our meeting re a proposed policy to regulate Ecigarettes, I have prepared the attached 2 page policy proposal and a draftaction plan.

I think that the SF Tobacco Free Coalition will want to support thisinitiative, but don't think they can take the lead given the othercompeting campaigns they have committed to that are part of our 3 yearplan. I think that Tomas, Rajiv and Airport folks would have the strongestinfluence on the supervisors as well as the Small Business Commission andshould take the lead on the critical ones as well as seeking theirendorsements. We have Coalition members from the American Cancer Society,American Heart Association, American Lung Association, SF Medical Society,BREATHE California and I can gather their endorsements.

The Tobacco Free Project might have some funds to pay a media consultant towork on the outlined media tasks, but this will depend on what funds areavailable for media once the costs of our media campaign for our smokefree housing objective are finalized.

I did not insert timelines for most of the activities as this will be afluid process. Many supervisors won't want to take a position until theyhear what concerns the Small Business Commission has, or may not takepositions until after a committee hearing takes place.

Please provide any feedback.

Tomas, please let me know how you would like to proceed and any revisionsyou would like on the attached documents.(See attached file: ECigPolicyProposal.doc)(See attached file: actionplan.doc)

2 attachments

ECigPolicyProposal.doc96K

action plan.doc40K

F/U on e-cig ABC interview2 messages

Tomas Aragon <tomas.aragon@sfdph.org> Sun, Apr 24, 2011 at 10:52 PMTo: Barbara Garcia <barbara.garcia@sfdph.org>

Barbara, Would like to briefly review the details of e-cig ABC interview and health commission process. We candiscuss at 8am meeting.

TomasP.S. Mon, 4/25, is LAST day of course at UCB SPH! I am giving a final exam.

=======Tomás J. Aragón, MD, DrPH, Health OfficerDirector, Population Health & PreventionSan Francisco Department of Public Health101 Grove St, Rm 308, SF CA 94102-4505G-Phone: 415-78-SALUD (415-787-2583)URL: http://www.sfdph.org

Barbara.Garcia@sfdph.org <Barbara.Garcia@sfdph.org> Mon, Apr 25, 2011 at 8:05 AMTo: Tomas Aragon <aragon@berkeley.edu>

Won't be ther till 830

From: Tomas Aragon [tomas.aragon@sfdph.org]Sent: 04/24/2011 10:52 PM MSTTo: Barbara GarciaSubject: F/U on e-cig ABC interview

E-cigarettes resolution?11 messages

Steve Heilig <heilig@sfms.org> Thu, Jun 2, 2011 at 3:13 PMTo: tomas.aragon@sfdph.org

Hi Tomas -

Wondering if you’ve had any movement on a resolution re e-cigarettes. Was remindedof that by this full-page ad in the NYTimes:http://www.thesafecig.com/

- it’s time for us to work up resolutions for CMA/AMA, and this might be a good topic.If you have thoughts/language, please let me know...

Thanks and best,

Steve Heilig, MPHSan Francisco Medical Society(415)561-0850x270http://www.sfms.org

Collaborative on Health and the Environmenthttp://www.healthandenvironment.org

Founding Co-Editor, Cambridge Quarterly of Healthcare Ethicshttp://journals.cambridge.org/action/displayJournal?jid=CQH

California Pacific Medical Center Program in Medicine and Human Valueshttp://www.cpmc.org/services/ethics/

Tomas Aragon <tomas.aragon@sfdph.org> Fri, Jun 3, 2011 at 9:44 AMTo: Steve Heilig <heilig@sfms.org>Cc: Colleen Chawla <colleen.chawla@sfdph.org>

Thanks Steve. We are going through our Health Commission to get a resolution. I believe a letter of support fromSFMS would be useful (we can provide draft).

I am ccing Colleen so she can guide us on the process.

=======Tomás J. Aragón, MD, DrPHHealth Officer, City & County of San FranciscoDeputy Director, SF Department of Public Health

p y pDirector, Population Health & Prevention, SFDPH101 Grove St, Rm 308, SF CA 94102-4505G-Phone: 415-78-SALUD (415-787-2583)

Colleen Chawla <Colleen.Chawla@sfdph.org> Sat, Jun 4, 2011 at 5:09 PMTo: Steve Heilig <heilig@sfms.org>Cc: Tomas Aragon <Tomas.Aragon@sfdph.org>, Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>

Hi Steve,

Thank you for this information. Alyonik Hrushow is scheduled to go to theHealth Commission's Community and Public Health Committee at 2pm on 6/21and then to the full Commission sometime thereafter (perhaps 7/19). Thegoal is to secure the Health Commission's support to pursue legislation toextend local ordinances prohibiting smoking in various areas to apply alsoto electronic cigarettes.

I'm sure your support of this effort would be much appreciated. I'mcopying Alyonik here.

Please let me know if you have any questions.

Colleen

Steve Heilig<heilig@sfms.org>

To06/03/2011 12:17 <colleen.chawla@sfdph.org>PM cc

SubjectFW: E-cigarettes resolution?

Hi Colleen -Just by way of more info, we do policy resolutions each year forSF/CA/national use. Would be great, I think, to have one jointly withSFDPH; I will paste a sample of what we do, for format purposes if that isuseful, and maybe we can do one on ecigs that fits both needs....

***ALCOHOL TAXES FOR EDUCATION, PREVENTION AND TREATMENTADOPTED BY CALIFORNIA MEDICAL ASSOCIATION, 2009

Authors: Gordon Fung, MD, Robert Liner, MD, and Steve Heilig, MPHSan Francisco Medical Society

Whereas, Marin Institute, a non-profit organization dedicated to preventingalcohol-related harm, published a study in 2008 titled "The Cost of Alcoholin California,” which estimated economic costs in California fromalcohol-related harm at $38 billion per year -- $18 billion for illness, $8billion in traffic costs, $8 billion for crime, and $4 billion forinjuries- about twice the economic cost attributed to tobacco use, withmuch of these costs borne by taxpayers; and

Whereas, current alcohol taxes only raise $336 million per year, theequivalent of less than 1 percent of the costs, California taxes on alcoholhave not increased since 1992 and then by only 1 cent; Marin Institute’srecommended 25-cents tax would raise more than $3.4 billion per year; and

Whereas, there is now much successful experience with taxing tobaccoproducts to pay for tobacco-related costs and programs, and proposals toincrease alcohol taxes are being proposed and enacted in states around thenation; and

Whereas, a recent review published in the American Journal of Public Healthconcluded that "Increasing alcohol taxes saves lives; that's the bottomline"; and

Whereas, the CMA House of Delegates in 2008 endorsed a “voluntary” fundestablished by the alcohol industry, which has not transpired, and the AMAalready endorses increased federal taxes on alcoholic beverages, andencourages states to advocate for higher taxes with revenues targeted atprevention and treatment of alcohol-related harms, and states that “whenstate legislative efforts to increase alcohol taxes are stymied, encouragestate medical societies to give consideration to the use of ballotinitiatives in the 24 states that allow such initiatives” (Res. 438, A-05);now be it

RESOLVED: That the CMA supports increasing alcohol taxes in California;and be it further

RESOLVED: That CMA advocate that any measure to increase alcohol taxesshould allocate money to alcohol-related education, outreach, prevention,and treatment programs.

------ Forwarded MessageFrom: Tomas Aragon <tomas.aragon@sfdph.org>Date: Fri, 3 Jun 2011 09:45:34 -0700To: Office 2004 Test Drive Steve <heilig@sfms.org>

g@ gCc: Colleen Chawla <colleen.chawla@sfdph.org>Subject: Re: E-cigarettes resolution?

Thanks Steve. We are going through our Health Commission to get aresolution. I believe a letter of support from SFMS would be useful (wecan provide draft).

=======Tomás J. Aragón, MD, DrPHHealth Officer, City & County of San FranciscoDeputy Director, SF Department of Public HealthDirector, Population Health & Prevention, SFDPH101 Grove St, Rm 308, SF CA 94102-4505G-Phone: 415-78-SALUD (415-787-2583)

On Thu, Jun 2, 2011 at 3:13 PM, Steve Heilig <heilig@sfms.org> wrote:Hi Tomas -

Wondering if you’ve had any movement on a resolution ree-cigarettes. Was reminded of that by this full-page ad in theNYTimes:http://www.thesafecig.com/

- it’s time for us to work up resolutions for CMA/AMA, and this mightbe a good topic. If you have thoughts/language, please let meknow...

Thanks and best,

Steve Heilig, MPHSan Francisco Medical Society(415)561-0850x270 <tel:%28415%29561-0850x270>http://www.sfms.org

California Pacific Medical Center Program in Medicine and HumanValueshttp://www.cpmc.org/services/ethics/

------ End of Forwarded Message

Steve Heilig <heilig@sfms.org> Mon, Jun 6, 2011 at 12:04 PMTo: Colleen Chawla <Colleen.Chawla@sfdph.org>, Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>Cc: Tomas Aragon <Tomas.Aragon@sfdph.org>

Hi all -

We have our SFMS delegation to CMA meeting, where new policy resolutions arereviewed, next Monday evening the 13th. Would be good to have even a very roughdraft of a state resolution to refine there. Any chance?

Format sample below:***ALCOHOL TAXES FOR EDUCATION, PREVENTION AND TREATMENTADOPTED BY CALIFORNIA MEDICAL ASSOCIATION, 2009

Authors: Gordon Fung, MD, Robert Liner, MD, and Steve Heilig, MPHSan Francisco Medical Society

Whereas, Marin Institute, a non-profit organization dedicated to preventingalcohol-related harm, published a study in 2008 titled "The Cost of Alcohol inCalifornia,” which estimated economic costs in California from alcohol-relatedharm at $38 billion per year -- $18 billion for illness, $8 billion in traffic costs,$8 billion for crime, and $4 billion for injuries- about twice the economic costattributed to tobacco use, with much of these costs borne by taxpayers; and

Whereas, current alcohol taxes only raise $336 million per year, the equivalentof less than 1 percent of the costs, California taxes on alcohol have notincreased since 1992 and then by only 1 cent; Marin Institute’s recommended25-cents tax would raise more than $3.4 billion per year; and

Whereas, there is now much successful experience with taxing tobacco productsto pay for tobacco-related costs and programs, and proposals to increasealcohol taxes are being proposed and enacted in states around the nation; and

Whereas, a recent review published in the American Journal of Public Healthconcluded that "Increasing alcohol taxes saves lives; that's the bottom line";and

Whereas, the CMA House of Delegates in 2008 endorsed a “voluntary” fundestablished by the alcohol industry, which has not transpired, and the AMAalready endorses increased federal taxes on alcoholic beverages, andencourages states to advocate for higher taxes with revenues targeted atprevention and treatment of alcohol-related harms, and states that “when statelegislative efforts to increase alcohol taxes are stymied, encourage statemedical societies to give consideration to the use of ballot initiatives in the 24states that allow such initiatives” (Res. 438, A-05); now be it

RESOLVED: That the CMA supports increasing alcohol taxes in California; andbe it further

RESOLVED: That CMA advocate that any measure to increase alcohol taxesshould allocate money to alcohol-related education, outreach, prevention, andtreatment programs.

On 6/4/11 5:15 PM, "Colleen Chawla" <Colleen.Chawla@sfdph.org> wrote:

Hi Steve,

Thank you for this information. Alyonik Hrushow is scheduled to go to theHealth Commission's Community and Public Health Committee at 2pm on6/21 and then to the full Commission sometime thereafter (perhaps 7/19).The goal is to secure the Health Commission's support to pursue legislationto extend local ordinances prohibiting smoking in various areas to apply alsoto electronic cigarettes.

I'm sure your support of this effort would be much appreciated. I'm copyingAlyonik here.

Colleen

Steve Heilig <heilig@sfms.org> 06/03/2011 12:17 PM

<colleen.chawla@sfdph.org>

ccSubject

FW: E-cigarettes resolution?

Hi Colleen -Just by way of more info, we do policy resolutions each year forSF/CA/national use. Would be great, I think, to have one jointly with SFDPH;

I will paste a sample of what we do, for format purposes if that is useful, andmaybe we can do one on ecigs that fits both needs....

***ALCOHOL TAXES FOR EDUCATION, PREVENTION ANDTREATMENTADOPTED BY CALIFORNIA MEDICAL ASSOCIATION, 2009

Authors: Gordon Fung, MD, Robert Liner, MD, and SteveHeilig, MPHSan Francisco Medical Society

Whereas, Marin Institute, a non-profit organizationdedicated to preventing alcohol-related harm, published astudy in 2008 titled "The Cost of Alcohol in California,”which estimated economic costs in California from alcohol-related harm at $38 billion per year -- $18 billion for illness,$8 billion in traffic costs, $8 billion for crime, and $4 billionfor injuries- about twice the economic cost attributed totobacco use, with much of these costs borne by taxpayers;and

Whereas, current alcohol taxes only raise $336 million peryear, the equivalent of less than 1 percent of the costs,California taxes on alcohol have not increased since 1992and then by only 1 cent; Marin Institute’s recommended25-cents tax would raise more than $3.4 billion per year;and

Whereas, there is now much successful experience withtaxing tobacco products to pay for tobacco-related costsand programs, and proposals to increase alcohol taxes arebeing proposed and enacted in states around the nation;and

Whereas, a recent review published in the American Journal

Whereas, a recent review published in the American Journalof Public Health concluded that "Increasing alcohol taxes saves lives;that's the bottom line"; and

Whereas, the CMA House of Delegates in 2008 endorsed a “voluntary” fundestablished by the alcohol industry, which has not transpired, and the AMAalready endorses increased federal taxes on alcoholic beverages, andencourages states to advocate for higher taxes with revenues targeted atprevention and treatment of alcohol-related harms, and states that “whenstate legislative efforts to increase alcohol taxes are stymied, encouragestate medical societies to give consideration to the use of ballot initiatives inthe 24 states that allow such initiatives” (Res. 438, A-05); now be it

RESOLVED: That CMA advocate that any measure toincrease alcohol taxes should allocate money to alcohol-related education, outreach, prevention, and treatmentprograms.

------ Forwarded MessageFrom: Tomas Aragon <tomas.aragon@sfdph.org<tomas.aragon@sfdph.org> >Date: Fri, 3 Jun 2011 09:45:34 -0700To: Office 2004 Test Drive Steve <heilig@sfms.org <heilig@sfms.org> >Cc: Colleen Chawla <colleen.chawla@sfdph.org <colleen.chawla@sfdph.org>>Subject: Re: E-cigarettes resolution?

Thanks Steve. We are going through our Health Commission to get aresolution. I believe a letter of support from SFMS would be useful (we canprovide draft).

=======Tomás J. Aragón, MD, DrPHHealth Officer, City & County of San FranciscoDeputy Director, SF Department of Public HealthDirector, Population Health & Prevention, SFDPH101 Grove St, Rm 308, SF CA 94102-4505

0 G o e St, 308, S C 9 0 505

G-Phone: 415-78-SALUD (415-787-2583)

On Thu, Jun 2, 2011 at 3:13 PM, Steve Heilig <heilig@sfms.org<heilig@sfms.org> > wrote:Hi Tomas -

Wondering if you’ve had any movement on a resolution re e-cigarettes. Wasreminded of that by this full-page ad in the NYTimes:http://www.thesafecig.com/ <http://www.thesafecig.com/>

- it’s time for us to work up resolutions for CMA/AMA, and this might be agood topic. If you have thoughts/language, please let me know...

Thanks and best,

Steve Heilig, MPHSan Francisco Medical Society(415)561-0850x270 <tel:%28415%29561-0850x270>http://www.sfms.org <http://www.sfms.org/>

Collaborative on Health and the Environmenthttp://www.healthandenvironment.org <http://www.healthandenvironment.org/>

Founding Co-Editor, Cambridge Quarterly of Healthcare Ethicshttp://journals.cambridge.org/action/displayJournal?jid=CQH<http://journals.cambridge.org/action/displayJournal?jid=CQH>

California Pacific Medical Center Program in Medicine and HumanValueshttp://www.cpmc.org/services/ethics/<http://www.cpmc.org/services/ethics/>

Colleen Chawla <Colleen.Chawla@sfdph.org> Mon, Jun 6, 2011 at 12:34 PMTo: Susana Hennessey-Lavery <Susana.Hennessey-Lavery@sfdph.org>, Mele Lau-Smith <Mele.Lau-Smith@sfdph.org>Cc: Tomas Aragon <Tomas.Aragon@sfdph.org>, Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>

Susana and Mele,

I know that Alyonik is out of town. Please see the email exchange with theSF Medical Society, below. I let Steve know that e-cigarettes will bebefore Committee at the Health Commission on 6/21. Do you have anysuggestions as to a policy recommendation they might advocate for at thestate level?

Thanks,Colleen----- Forwarded by Colleen Chawla/DPH/SFGOV on 06/06/2011 12:31 PM -----

To06/06/2011 12:04 Colleen ChawlaPM <Colleen.Chawla@sfdph.org>, Alyonik

Hrushow <Alyonik.Hrushow@sfdph.org>cc

Tomas Aragon<Tomas.Aragon@sfdph.org>

Colleen Chawla <Colleen.Chawla@sfdph.org> Mon, Jun 6, 2011 at 12:53 PMTo: Steve Heilig <heilig@sfms.org>Cc: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>, Tomas Aragon <Tomas.Aragon@sfdph.org>

Hi Steve,

Alyonik is out of town this week. But, I'm checking with her staff and will get back to you.

Thanks much,Colleen

Steve Heilig <heilig@sfms.org>

06/06/2011 12:04 PM

To Colleen Chawla <Colleen.Chawla@sfdph.org>, Alyonik Hrushow<Alyonik.Hrushow@sfdph.org>

cc Tomas Aragon <Tomas.Aragon@sfdph.org>

Subject Re: E-cigarettes resolution?

Susana Hennessey-Lavery <Susana.Hennessey-Lavery@sfdph.org> Mon, Jun 6, 2011 at 3:43 PMTo: Colleen Chawla <Colleen.Chawla@sfdph.org>Cc: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>, Mele Lau-Smith <Mele.Lau-Smith@sfdph.org>, aragon<Tomas.Aragon@sfdph.org>

Hi Colleen,

We feel that similar policy language to that which is outlined in the SFHCresolution could be appropriate at the state level. In fact this

resolution is based on a resolution developed by the Technical AssistanceLegal Center for the state of New York. Its contains the following policyrecommendations:

1. Prohibit the use of electronic cigarettes and other nicotine deliverydevices not approved by the FDA as smoking cessation aids in thoseplaces where smoking is prohibited by law.2. Require a tobacco permit for the sale or furnishing of electroniccigarettes and other nicotine delivery devices not approved by the FDAas smoking cessation aids

Here's the HC resolution.(See attached file: HCommRes4.2011.doc)

Also, here's the e-cig policy adopted by the Airport Commission.

(See attached file: AirportCommPolicy9.30.10.pdf)

Please let me know if there's anything else you need.

susana

Susana Hennessey LaverySan Francisco Department of Public HealthCommunity Health Promotion & Prev. BranchTobacco Free Project30 Van Ness, #2300San Francisco, California 94102415-581-2446

ColleenChawla/DPH/SFGOV

To06/06/2011 12:34 SusanaPM Hennessey-Lavery/DPH/SFGOV@SFGOV,

Mele Lau-Smith/DPH/SFGOV@SFGOVcc

Tomas Aragon, AlyonikHrushow/DPH/SFGOV@SFGOV

SubjectFw: E-cigarettes resolution?

Susana and Mele,

2 attachments

HCommRes4.2011.doc49K

AirportCommPolicy9.30.10.pdf93K

Colleen Chawla <Colleen.Chawla@sfdph.org> Mon, Jun 6, 2011 at 6:51 PMTo: Susana Hennessey-Lavery <Susana.Hennessey-Lavery@sfdph.org>Cc: Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>, aragon@berkeley.edu, Mele Lau-Smith <Mele.Lau-Smith@sfdph.org>

Thanks, Susana! I'll pass this on with the caveat that DPH cannot co-sponsor any policy resolution with SFMSwithout prior approval by the Health Commission.

Susana Hennessey-Lavery/DPH/SFGOV

06/06/2011 03:43 PM

To Colleen Chawla/DPH/SFGOV@SFGOV

cc Alyonik Hrushow/DPH/SFGOV@SFGOV, Mele Lau-Smith/DPH/SFGOV@SFGOV, aragon@berkeley.edu@SFGOV

Subject Re: Fw: E-cigarettes resolution?Link

Hi Colleen,

We feel that similar policy language to that which is outlined in the SFHC resolution could be appropriate at thestate level. In fact this resolution is based on a resolution developed by the Technical Assistance Legal Center forthe state of New York. Its contains the following policy recommendations:

1. Prohibit the use of electronic cigarettes and other nicotine delivery devices not approved by theFDA as smoking cessation aids in those places where smoking is prohibited by law.2. Require a tobacco permit for the sale or furnishing of electronic cigarettes and other nicotinedelivery devices not approved by the FDA as smoking cessation aids

Here's the HC resolution.[attachment "HCommRes4.2011.doc" deleted by Colleen Chawla/DPH/SFGOV]

[attachment "AirportCommPolicy9.30.10.pdf" deleted by Colleen Chawla/DPH/SFGOV]

susana

Colleen Chawla/DPH/SFGOV

06/06/2011 12:34 PM

To Susana Hennessey-Lavery/DPH/SFGOV@SFGOV, Mele Lau-Smith/DPH/SFGOV@SFGOV

cc Tomas Aragon, Alyonik Hrushow/DPH/SFGOV@SFGOV

Subject Fw: E-cigarettes resolution?

Susana and Mele,

I know that Alyonik is out of town. Please see the email exchange with the SF Medical Society, below. I letSteve know that e-cigarettes will be before Committee at the Health Commission on 6/21. Do you have anysuggestions as to a policy recommendation they might advocate for at the state level?

Steve Heilig <heilig@sfms.org>

06/06/2011 12:04 PM

To Colleen Chawla <Colleen.Chawla@sfdph.org>, Alyonik Hrushow<Alyonik.Hrushow@sfdph.org>

cc Tomas Aragon <Tomas.Aragon@sfdph.org>

Subject Re: E-cigarettes resolution?

Colleen Chawla <Colleen.Chawla@sfdph.org> Mon, Jun 6, 2011 at 6:57 PMTo: heilig@sfms.orgCc: Tomas Aragon <Tomas.Aragon@sfdph.org>, Alyonik Hrushow <Alyonik.Hrushow@sfdph.org>

Hi Steve,

Attached is the draft resolution we are proposing for the HealthCommission's consideration. Please note that this has not yet beenpresented (even in draft form) to the Health Commission, Also attached isthe Airport Commission's e-cigarette policy.

DPH would not be able to co-sponsor any policy resolution on this issuewith SFMS prior to consideration by the Health Commission. However,perhaps these documents provide enough information on our proposeddirection to be helpful to you for next week.

Please let me know your thoughts and/or if you have any questions.

Best,Colleen

Colleen ChawlaInterim Deputy DirectorDirector of Policy and PlanningSan Francisco Department of Public Health415.554.2769colleen.chawla@sfdph.org----- Forwarded by Colleen Chawla/DPH/SFGOV on 06/06/2011 06:51 PM -----

SusanaHennessey-Lavery/DPH/SFGOV To

Colleen Chawla/DPH/SFGOV@SFGOV06/06/2011 03:43 ccPM Alyonik Hrushow/DPH/SFGOV@SFGOV,

Mele Lau-Smith/DPH/SFGOV@SFGOV,aragon@berkeley.edu@SFGOV

SubjectRe: Fw: E-cigarettes resolution?(Document link: Colleen Chawla)

Hi Colleen,

We feel that similar policy language to that which is outlined in the SFHCresolution could be appropriate at the state level. In fact thisresolution is based on a resolution developed by the Technical AssistanceLegal Center for the state of New York. Its contains the following policyrecommendations:

1. Prohibit the use of electronic cigarettes and other nicotine deliverydevices not approved by the FDA as smoking cessation aids in thoseplaces where smoking is prohibited by law.2. Require a tobacco permit for the sale or furnishing of electroniccigarettes and other nicotine delivery devices not approved by the FDAas smoking cessation aids

Here's the HC resolution.(See attached file: HCommRes4.2011.doc)

(See attached file: AirportCommPolicy9.30.10.pdf)

susana

To06/06/2011 12:34 SusanaPM Hennessey-Lavery/DPH/SFGOV@SFGOV,

Mele Lau-Smith/DPH/SFGOV@SFGOVcc

SubjectFw: E-cigarettes resolution?

Susana and Mele,

2 attachments

HCommRes4.2011.doc49K

AirportCommPolicy9.30.10.pdf93K

Steve Heilig <heilig@sfms.org> Thu, Jun 9, 2011 at 12:13 PMTo: Colleen Chawla <Colleen.Chawla@sfdph.org>Cc: Tomas Aragon <Tomas.Aragon@sfdph.org>

Hi Coleen – this is great; will adapt some for SFMS/CMA purpose/format.One Q – I wonder if best to simplify/broaden ‘resolved’ to just state something like ‘allexisting laws and regulations pertaining to tobacco shall apply to e-cigs”?A thought..

And – our deadline for this is Aug. 15. If health commission has adopted by then, wecould add Tomas as a co-author...

Thanks much!SH

On 6/6/11 7:00 PM, "Colleen Chawla" <Colleen.Chawla@sfdph.org> wrote:

Hi Steve,

Attached is the draft resolution we are proposing for the HealthCommission's consideration. Please note that this has not yet beenpresented (even in draft form) to the Health Commission, Also attached isthe Airport Commission's e-cigarette policy.

DPH would not be able to co-sponsor any policy resolution on this issue withSFMS prior to consideration by the Health Commission. However, perhapsthese documents provide enough information on our proposed direction to behelpful to you for next week.

Please let me know your thoughts and/or if you have any questions.

Best,Colleen

Colleen ChawlaInterim Deputy DirectorDirector of Policy and PlanningSan Francisco Department of Public Health415.554.2769colleen.chawla@sfdph.org----- Forwarded by Colleen Chawla/DPH/SFGOV on 06/06/2011 06:51 PM -----Susana Hennessey-Lavery/DPH/SFGOV 06/06/2011 03:43 PM

Colleen Chawla/DPH/SFGOV@SFGOV

Alyonik Hrushow/DPH/SFGOV@SFGOV, Mele Lau-Smith/DPH/SFGOV@SFGOV,aragon@berkeley.edu@SFGOV

Subject

Re: Fw: E-cigarettes resolution?Link <Notes://lnm03b02/882576EE005DCCF5/38D46BF5E8F08834852564B500129B2C/6D4E1179C7FCFAC6882578A7006B417C>

Hi Colleen,

We feel that similar policy language to that which is outlined in the SFHCresolution could be appropriate at the state level. In fact this resolution isbased on a resolution developed by the Technical Assistance Legal Center forthe state of New York. Its contains the following policy recommendations:

1 P hibit th f l t i i tt d th i ti d li

1. Prohibit the use of electronic cigarettes and other nicotine deliverydevices not approved by the FDA as smoking cessation aids in those placeswhere smoking is prohibited by law.2. Require a tobacco permit for the sale or furnishing of electroniccigarettes and other nicotine delivery devices not approved by the FDA assmoking cessation aids

Here's the HC resolution.

susana

Colleen Chawla/DPH/SFGOV 06/06/2011 12:34 PM

Susana Hennessey-Lavery/DPH/SFGOV@SFGOV, Mele Lau-Smith/DPH/SFGOV@SFGOV

Tomas Aragon, Alyonik Hrushow/DPH/SFGOV@SFGOV

Subject

Fw: E-cigarettes resolution?

Susana and Mele,

I know that Alyonik is out of town. Please see the email exchange with theSF Medical Society, below. I let Steve know that e-cigarettes will be beforeCommittee at the Health Commission on 6/21. Do you have any suggestionsas to a policy recommendation they might advocate for at the state level?

Thanks,Colleen----- Forwarded by Colleen Chawla/DPH/SFGOV on 06/06/2011 12:31 PM -----Steve Heilig <heilig@sfms.org> 06/06/2011 12:04 PM

Colleen Chawla <Colleen.Chawla@sfdph.org>, Alyonik Hrushow<Alyonik.Hrushow@sfdph.org>

Tomas Aragon <Tomas.Aragon@sfdph.org>

Subject

Re: E-cigarettes resolution?

Hi all -

We have our SFMS delegation to CMA meeting, where new policy resolutionsare reviewed, next Monday evening the 13th. Would be good to have evena very rough draft of a state resolution to refine there. Any chance?

Format sample below:***ALCOHOL TAXES FOR EDUCATION, PREVENTION ANDTREATMENTADOPTED BY CALIFORNIA MEDICAL ASSOCIATION, 2009

Authors: Gordon Fung, MD, Robert Liner, MD, and SteveHeilig, MPHSan Francisco Medical Society

Whereas, Marin Institute, a non-profit organizationdedicated to preventing alcohol-related harm, published astudy in 2008 titled "The Cost of Alcohol in California,”which estimated economic costs in California from alcohol-

related harm at $38 billion per year -- $18 billion for illness,$8 billion in traffic costs, $8 billion for crime, and $4 billionfor injuries- about twice the economic cost attributed totobacco use, with much of these costs borne by taxpayers;and

Whereas, current alcohol taxes only raise $336 million peryear, the equivalent of less than 1 percent of the costs,California taxes on alcohol have not increased since 1992and then by only 1 cent; Marin Institute’s recommended25-cents tax would raise more than $3.4 billion per year;and

Whereas, there is now much successful experience withtaxing tobacco products to pay for tobacco-related costsand programs, and proposals to increase alcohol taxes arebeing proposed and enacted in states around the nation;and

Whereas, a recent review published in the American Journalof Public Health concluded that "Increasing alcohol taxes saves lives;that's the bottom line"; and

RESOLVED: That CMA advocate that any measure toincrease alcohol taxes should allocate money to alcohol-related education, outreach, prevention, and treatmentprograms.

On 6/4/11 5:15 PM, "Colleen Chawla" <Colleen.Chawla@sfdph.org<Colleen.Chawla@sfdph.org> > wrote:

Hi Steve,

Thank you for this information. Alyonik Hrushow is scheduled to go to theHealth Commission's Community and Public Health Committee at 2pm on6/21 and then to the full Commission sometime thereafter (perhaps 7/19).The goal is to secure the Health Commission's support to pursue legislationto extend local ordinances prohibiting smoking in various areas to apply alsoto electronic cigarettes.

I'm sure your support of this effort would be much appreciated. I'm copyingAlyonik here.

Colleen

Steve Heilig <heilig@sfms.org <heilig@sfms.org> > 06/03/2011 12:17PMTo<colleen.chawla@sfdph.org <colleen.chawla@sfdph.org> >ccSubjectFW: E-cigarettes resolution?

Hi Colleen -Just by way of more info, we do policy resolutions each year forSF/CA/national use. Would be great, I think, to have one jointly with SFDPH;I will paste a sample of what we do, for format purposes if that is useful, andmaybe we can do one on ecigs that fits both needs....

ALCOHOL TAXES FOR EDUCATION

ALCOHOL TAXES FOR EDUCATION,PREVENTION AND TREATMENTADOPTED BY CALIFORNIA MEDICALASSOCIATION, 2009

Authors: Gordon Fung, MD, Robert Liner, MD,and Steve Heilig, MPHSan Francisco Medical Society

Whereas, Marin Institute, a non-profitorganization dedicated to preventing alcohol-related harm, published a study in 2008 titled"The Cost of Alcohol in California,” whichestimated economic costs in California fromalcohol-related harm at $38 billion per year --$18 billion for illness, $8 billion in traffic costs,$8 billion for crime, and $4 billion for injuries-about twice the economic cost attributed totobacco use, with much of these costs borneby taxpayers; and

Whereas, current alcohol taxes only raise $336million per year, the equivalent of less than 1percent of the costs, California taxes on alcoholhave not increased since 1992 and then byonly 1 cent; Marin Institute’s recommended25-cents tax would raise more than $3.4 billionper year; and

Whereas, there is now much successfulexperience with taxing tobacco products to pay

experience with taxing tobacco products to pay

for tobacco-related costs and programs, andproposals to increase alcohol taxes are beingproposed and enacted in states around thenation; and

Whereas, a recent review published in theAmerican Journal of Public Health concluded that"Increasing alcohol taxes saves lives; that's the bottom line"; and

RESOLVED: That CMA advocate that anymeasure to increase alcohol taxes shouldallocate money to alcohol-related education,outreach, prevention, and treatment programs.

------ Forwarded MessageFrom: Tomas Aragon <tomas.aragon@sfdph.org<tomas.aragon@sfdph.org> <tomas.aragon@sfdph.org<tomas.aragon@sfdph.org> > >Date: Fri, 3 Jun 2011 09:45:34 -0700To: Office 2004 Test Drive Steve <heilig@sfms.org <heilig@sfms.org><heilig@sfms.org <heilig@sfms.org> > >Cc: Colleen Chawla <colleen.chawla@sfdph.org <colleen.chawla@sfdph.org><colleen.chawla@sfdph.org <colleen.chawla@sfdph.org> > >Subject: Re: E-cigarettes resolution?

Subject: Re: E cigarettes resolution?

Thanks Steve. We are going through our Health Commission to get aresolution. I believe a letter of support from SFMS would be useful (we canprovide draft).

On Thu, Jun 2, 2011 at 3:13 PM, Steve Heilig <heilig@sfms.org<heilig@sfms.org> <heilig@sfms.org <heilig@sfms.org> > > wrote:Hi Tomas -

Wondering if you’ve had any movement on a resolution re e-cigarettes. Wasreminded of that by this full-page ad in the NYTimes:http://www.thesafecig.com/ <http://www.thesafecig.com/> <http://<http:///> www.thesafecig.com/>

- it’s time for us to work up resolutions for CMA/AMA, and this might be agood topic. If you have thoughts/language, please let me know...

Thanks and best,

Steve Heilig, MPHSan Francisco Medical Society(415)561-0850x270 <tel:%28415%29561-0850x270>http://www.sfms.org <http://www.sfms.org/> <http:// <http:///>www.sfms.org/>

Collaborative on Health and the Environmenthttp://www.healthandenvironment.org <http://www.healthandenvironment.org/> <http:// <http:///>www.healthandenvironment.org/>

Founding Co-Editor, Cambridge Quarterly of Healthcare Ethicshttp://journals.cambridge.org/action/displayJournal?jid=CQH<http://journals.cambridge.org/action/displayJournal?jid=CQH><http://journals.cambridge.org/action/displayJournal?jid=CQH

<http://journals.cambridge.org/action/displayJournal?jid=CQH> >

California Pacific Medical Center Program in Medicine and HumanValueshttp://www.cpmc.org/services/ethics/<http://www.cpmc.org/services/ethics/> <http:// <http:///>www.cpmc.org/services/ethics/>

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Mon, Jun 13, 2011 at 11:19 AMTo: Steve Heilig <heilig@sfms.org>Cc: Colleen Chawla <Colleen.Chawla@sfdph.org>, tomas.aragon@sfdph.org

Hi SteveHope you are doing well. It would be great if the SFMS provided supportfor the e cig policy that will be proposed to the Health Commission.

To06/04/2011 05:09 Steve Heilig <heilig@sfms.org>PM cc

SubjectRe: FW: E-cigarettes resolution?(Document link: Alyonik Hrushow)

Hi Steve,

Thank you for this information. Alyonik Hrushow is scheduled to go to theHealth Commission's Community and Public Health Committee at 2pm on 6/21and then to the full Commission sometime thereafter (perhaps 7/19). Thegoal is to secure the Health Commission's support to pursue legislation to

extend local ordinances prohibiting smoking in various areas to apply also

to electronic cigarettes.

I'm sure your support of this effort would be much appreciated. I'mcopying Alyonik here.

Colleen

To06/03/2011 12:17 <colleen.chawla@sfdph.org>PM cc

Date: Fri, 3 Jun 2011 09:45:34 -0700To: Office 2004 Test Drive Steve <heilig@sfms.org>Cc: Colleen Chawla <colleen.chawla@sfdph.org>Subject: Re: E-cigarettes resolution?

Thanks Steve. We are going through our Health Commission to get aresolution. I believe a letter of support from SFMS would be useful (wecan provide draft).

On Thu, Jun 2, 2011 at 3:13 PM, Steve Heilig <heilig@sfms.org> wrote:Hi Tomas -

Wondering if you’ve had any movement on a resolution ree-cigarettes. Was reminded of that by this full-page ad in theNYTimes:http://www.thesafecig.com/

- it’s time for us to work up resolutions for CMA/AMA, and this mightbe a good topic. If you have thoughts/language, please let meknow...

Thanks and best,

Steve Heilig, MPHSan Francisco Medical Society(415)561-0850x270 <tel:%28415%29561-0850x270>http://www.sfms.org

California Pacific Medical Center Program in Medicine and HumanValueshttp://www.cpmc.org/services/ethics/

revised e cig resolution language1 message

Alyonik Hrushow <Alyonik.Hrushow@sfdph.org> Tue, Jun 21, 2011 at 3:36 PMTo: tomas.aragon@sfdph.org

TomasHow does this sound to you?

1. Restrict the use of electronic cigarettes and other nicotine deliverydevices not approved by the FDA as smoking cessation aids in those areaswhere smoking has been prohibited in the San Francisco Health Code.

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